Background: The increasing prevalence of chronic diseases puts a high burden on the health care systems of Low\nand Middle Income Countries which are often not adapted to provide the care needed. Peer support programmes\nare promoted to address health system constraints. This case study analyses a peer educator diabetes programme\nin Cambodia, MoPoTsyo, from a health system�s perspective. Which strategies were used and how did these strategies\nchange? How is the programme perceived?\nMethods: Data were collected through semi-structured interviews with patients, MoPoTsyo staff and peer educators,\ncontracted pharmacy staff and health workers, health care workers and non-contracted pharmacists and managers and\npolicy makers at district, provincial and national level. Four areas were purposively selected to do the interviews.\nAn inductive content analysis was done independently by two researchers.\nResults: MoPoTsyo developed into three stages: a focus on diabetes self-management; a widening scope to\nensure affordable medicines and access to other health care services; and aiming for sustainability through more\nintegration with the Cambodian public system and further upscaling. All respondents acknowledged the peer educators�\nrole and competence in patient education, but their ideas about additional tasks and their place in the system differed.\nIndirectly involved stakeholders and district managers emphasized the particular roles and responsibilities of all actors in\nthe system and the particular role of the peer educator in the community. MoPoTsyo�s diagnostics and laboratory services\nwere perceived as useful, especially by patients and project staff. Respondents were positive about the revolving drug\nfund, but expressed concerns about its integration into the government system. The degree of collaboration between\nhealth care staff and peer educators varied.\nConclusion: MoPoTsyo responds to the needs of people with diabetes in Cambodia. Key success factors were: consistent\nfocus on and involvement of the target group, backed up by a strong organisation; simultaneous reduction of other\nbarriers to care; and the ongoing maintenance of relations at all levels within the health system. Despite resistance,\nMoPoTsyo has established a more balanced relationship between patients and health service providers, empowering\npatients to self-manage and access services that meet their needs.
Loading....