Stakeholders’ perspectives on the status of diabetic retinopathy and diabetes health service management systems in Uganda

Abstract

Abstract Background Diabetes retinopathy (DR) is a leading cause of vision loss in middle-aged and elderly people globally. Early detection and prompt treatment of DR can facilitate the prevention of diabetes-related visual impairment. Methods We used the Tool for Assessment of Diabetic Retinopathy and Diabetes Management System (TADDS) questionnaire to collect data on the stakeholders’ perspectives on the status of diabetes mellitus (DM) and DR health service management systems in Uganda to inform service improvement and scale-up. Data collection took place in February 2019. Data were collected on the seven TADDS thematic areas (i.e., availability of DR and DM priorities, policies, and programs; service delivery; health workforce; health technology; health information management system; health promotion, and health financing) from 40 key stakeholders drawn from the Ministry of Health, World Health Organization, Lions Clubs International Foundation and 18 health facilities across the country. A national-level validation meeting was conducted in April 2019 to validate the study findings. Results While diabetes mellitus is a recognized non-communicable disease in Uganda, the country lacks a guiding program for its management. It does not have a budget for diabetes management and control, and there is limited involvement of stakeholders in diabetes mellitus programming. Similarly, although diabetic retinopathy is a recognized complication of diabetes mellitus, its prevalence is unknown and information about its management is not readily available. The provision of DR and DM services is limited to the regional or tertiary level of care (which limits access to a majority of the population in need), while both DM and DR continue to be managed as parallel rather than integrated disease programs. Shortages in trained health workforce, lack of equipment and supplies, and the high patient costs continue to affect people’s access to DM and DR services in Uganda. Conclusion The DM and DR health service management systems are fraught with programmatic implementation challenges while both diseases continue to be managed as parallel rather than integrated disease programs. These findings call for urgent programmatic adjustments in the management of DM and DR services, including DM-DR integration, to improve the provision of ophthalmology services in Uganda.