PhD defence Vannarath Te

Supervisors

• Prof. Dr. Wim Van Damme (ITM)

• Prof. Dr. Josefien van Olmen (University of Antwerp)

• Prof. Dr. Edwin Wouters (University of Antwerp)

• Dr. Por Ir (National Institute of Public Health, Cambodia)

Abstract

Type 2 Diabetes (T2D) is one of the major risk factors for cardiovascular diseases accountable for almost one third of the total global deaths in 2021. Cambodia has also been severely affected by the T2D epidemic. The incurable nature of T2D, along with its chronicity and silent progression, requires the condition to be diagnosed as early as possible, and to be managed properly and promptly on a regular basis to prevent or delay complications. However, T2D management in Cambodia has been limited. In order to address this, three main Diabetes Care Initiatives (DCIs) (hospital-based, health center-based, and community-based) are being scaled up in the Cambodian public healthcare system. The aim of this PhD study is to systematically evaluate performance of the three DCIs in providing T2D care to the population in Cambodia. 

A mixed-methods research with concurrent design was employed. Qualitative data and quantitative data were collected and analysed to inform and build on each other during a similar timeframe. The study collected data from multiple sources of data and levels of the health system (population level, healthcare organisation level, and policy level) between 2019-2020. The qualitative part involved document review, stakeholder interviews, and an in-depth analysis of implementation; while the quantitative part involved a population-based survey and an analysis of secondary data. A cascade of care framework adapted from the HIV program was employed to assess the T2D care continuum. Five operational health districts were purposively selected depending on availability of the DCIs, either individually or in co-existence, to ensure a maximal spread, which embodied the full spectrum of existing DCIs in Cambodia.

In overall, the performance of DCIs in the Cambodian public healthcare system in providing the T2D care continuum remained suboptimal. The co-existence of the three DCIs is not enough, but good implementation fidelity and coordination among them are necessary for the integrated care for T2D in primary health care of the operational district health system. A multidisciplinary healthcare team should be adopted to support patients in self-management of their T2D condition.  Community health workers should support the healthcare team to provide health education and self-management support to people with T2D and communities. They can be equipped to play a role as care coordinators to improve structured collaboration and organisation of care. Health centers (primary care level) should be strengthened as a locus for the provision of care continuity for T2D in the Cambodian public healthcare system.