Abstract:
Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and
innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the
group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery that has demonstrated beneficial impact previous pilot studies. However the contexual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low-
and middle-income country setting are not well known.Methods: Two types of qualitative group discussion were conducted: 1)
mabaraza (singular,
baraza), a
traditional East African community gathering used to discuss and exchange information in large group
settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers,
microfinance roup members, and patients with NCDs. Trained research staff members led the
discussions using structured question guides. Content analysis was performed with NVivo using
deductive and inductive codes that were then grouped into themes.Results: We conducted 5
mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women)
participated in the
mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs.
Participants expressed interest in participating in microfinance nd group medical visits, but cited several
key challenges: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-
economic fragility.Conclusions: Our qualitative study revealed and illuminated actionable factors that could impact the
success of implementation of group medical visits and microfinance itiatives for NCD care. While
several challenges were highlighted, participants also felt that planned interventions could address and
mitigate the impact of these dynamic factors. We anticipate that our approach and analysis provides new
insights and methodological techniques that will be relevant to other low-resource settings worldwide.
