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Provider Workload and Multiple Morbidities in the Caribbean and South Africa (lay summary)

This is a lay summary of the article published under the DOI: 10.1007/978-3-319-77685-9_5

Published onMay 02, 2023
Provider Workload and Multiple Morbidities in the Caribbean and South Africa (lay summary)

Its harder for people with both HIV and diabetes to get adequate healthcare

Managing HIV and diabetes together, both serious diseases, often takes a lot of time and energy, and many patients deal with social stigma and discrimination. Taking a more holistic approach to managing these diseases could reduce the burden on patients and improve the healthcare system in the process.

Suffering from a combination of HIV and another serious disease, like diabetes, is a common problem, especially for people living in parts of the world where rates of these diseases are high. 

In many cases, patients with 2 or more serious diseases must use separate parts of the healthcare system, like going to two different clinics, to receive treatment. This can make it difficult for healthcare services to give these patients the best care, and makes it harder for the patients themselves to manage their own health.

In this study, the researchers wanted to understand how people living with multiple diseases, also called comorbidities, were affected by needing to use different parts of the health system to access care. 

They also wanted to see whether it became more difficult for patients to cope with their diseases when they had to spend more time on medical visits, self-care, and treatments.

The researchers focused on patients in South Africa and the Caribbean, two areas with high rates of HIV and other chronic diseases. They asked patients with HIV and diabetes to explain how much time and energy they typically spent on treatment and managing their health. 

They were also interested in how well these patients were able to cope with their own healthcare requirements. For example, they asked whether patients had enough financial and social support, and whether they felt like they had enough information about managing the diseases.

In total, the researchers interviewed 21 patients in South Africa, and 20 in the Caribbean countries of Trinidad and Barbados. They then analysed the interviews to find out the main challenges the patients were dealing with.

In general, the study showed that patients with both HIV and diabetes were not receiving adequate healthcare services. In both parts of the world, the researchers found that patients spent a lot of time waiting in clinics. Both groups also mentioned spending a lot of time taking medicine and eating correctly to manage their diabetes.

In South Africa, patients reported a shortage of healthcare professionals and medicine as challenges they faced when getting treatment. They also faced social stigma, especially about having HIV. Many patients added that having financial and family support, enough information about the diseases and a positive attitude helped them overcome some of their problems.

In the Caribbean, patients reported losing income due to having to wait at clinics and expressed concerns about confidentiality when going for HIV treatment. Like patients in South Africa, Caribbean patients also faced stigma and discrimination to do with their HIV diagnosis, which added to the emotional and mental challenges of living with the disease.

The researchers said that these findings show that there is a need for healthcare systems to focus more on patients, rather than specific diseases, and to take a more holistic approach to care. For example, patients in the Caribbean wanted HIV facilities to also help with their other healthcare needs as well. 

The researchers added that healthcare systems should therefore be redesigned and expanded to improve treatment for people with comorbidities. They said this would help patients cope with challenges related to their diagnosis, and could improve healthcare systems by making sure resources are shared and maximised.

The study was a collaboration between scientists from Barbados, Trinidad and Tobago, South Africa and the USA.


This chapter discusses the current state of healthcare, challenges and potential local and cross-national solutions related to multiple morbidity in low and middle income countries and vulnerable populations in high income countries, based on interdisciplinary research of provider workload in South Africa and the Caribbean. With a high chronic and noncommunicable disease (NCD) and HIV burden in both settings, it is not uncommon to find patients having this double burden of disease. Additionally, patient resiliency is exacerbated by the multiplication of both demands made by the interactions from treatment modalities and multiple service providers. The Cumulative Complexity Model (CCM) posits that as the burden of disease and resulting workload increase, the patient capacity to respond to it diminishes. In middle and high-income countries, a dedicated system of care for people living with HIV/AIDS was developed in parallel to existing systems of care for NCDs, which has been successful in increasing advocacy, political will, and healthcare worker empowerment. We explore the application of this model across settings, along with other potential solutions.


This summary is a free resource intended to make African research and research that affects Africa, more accessible to non-expert global audiences. It was compiled by ScienceLink's team of professional African science communicators as part of the Masakhane MT: Decolonise Science project. ScienceLink has taken every precaution possible during the writing, editing, and fact-checking process to ensure that this summary is easy to read and understand, while accurately reporting on the facts presented in the original research paper. Note, however, that this summary has not been fact-checked or approved by the authors of the original research paper, so this summary should be used as a secondary resource. Therefore, before using, citing or republishing this summary, please verify the information presented with the original authors of the research paper, or email [email protected] for more information.

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