Improving Type II Diabetes Care in West Africa: A Scoping Review of Barriers, Facilitators and the Way Forward

Abstract

AbstractBackgroundThe prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa.MethodsOur scoping review followed Arksey and O’Malley’s methodology and PRISMA-ScR guidelines. We comprehensively searched electronic databases and grey literature for studies covering 2000-2023 that reported factors related to diabetes primary care in West African countries. Data was extracted and analysed through a framework synthesis approach integrating the World Health Organisation Operational Framework for Primary Health Care, the Social Determinants of Health model, and the Innovative Care for Chronic Conditions model.ResultsTwelve studies were included from Nigeria (n=7), Ghana (n=4), and Senegal (n=1). Key barriers to access, utilisation, and quality were identified as health system deficiencies, including lack of infrastructure, workforce shortages, supply gaps, fragmented care coordination, absence of standardised guidelines, high costs of care, and limited governance for chronic disease management. Broader determinants of health, such as poverty, gender, cultural beliefs, reliance on traditional medicine, and health policy gaps, were found to influence access to and utilisation of care significantly. Individual-level barriers like psychological distress and delays in care-seeking were also significant. However, family/social support systems emerged as potential facilitators of accessing and utilising PHC services.ConclusionsOur review indicates a complex interplay between health system deficiencies, deeply rooted cultural beliefs, and lived experiences shaping diabetes care in West Africa. The region’s unique challenges demand a paradigm shift from conventional chronic care models to context-specific, adaptive models. Crucially, the gendered aspects of care and the integration of traditional healing practices emerge as pivotal yet often overlooked factors in diabetes management. Furthermore, addressing the bidirectional relationship between mental health and diabetes offers a promising avenue for improving outcomes. Future strategies must transcend the biomedical model, embracing a sociocultural approach that leverages community assets and addresses structural inequities.