In rural Zimbabwe, men are challenging societal norms and breaking down barriers to access diabetes care. This is a story of unity and the power of knowledge.
16 October 2024 Andreea Enea
'We realised it was necessary to form an association. Why? So we could go and motivate our own, which are other men, who live in rural areas,' says Luckson Zanamwe, a member of a diabetes self-support group at Chikombedzi Hospital, Zimbabwe.
Luckson's group was formed as part of the 'Improving access and quality of diabetes care in rural Zimbabwe' project, funded by WDF.
This three-year initiative aims to decentralise standardised diagnosis, treatment, and follow-up of patients with diabetes to the primary level within three districts in Masvingo Province. The project also focuses on rolling out a comprehensive training package for healthcare workers, enhancing patient health literacy and community awareness on healthy lifestyle and disease prevention, and improving stakeholder coordination and NCD advocacy.
SolidarMed, a Swiss-based organisation committed to improving healthcare in south-eastern Africa, is leading this project. Their team has a long-term partnership with Zimbabwe's Ministry of Health and Child Care and focuses on health systems strengthening, innovation, and advocacy in areas like HIV, mother-child health, and non-communicable diseases (NCDs).
Recently, WDF’s programme managers Helen Wamuyu Chege and Mikkel Pape Dysted travelled to Zimbabwe to discuss the project’s progress with our partners.
During their visit, they also met with the Chikombedzi Hospital’s diabetes patient support group, one of the several groups established by SolidarMed under the WDF project, to understand their lived experiences and challenges.
Composed solely of men, this particular group is breaking down barriers and challenging the societal norms that often delay men from seeking healthcare.
In Zimbabwe, where nearly 40% of the population lives on less than $2.15 a day, significant health issues persist, especially in managing NCDs. According to the World Health Organisation, NCDs account for 31% of total deaths in the country. This high mortality rate reflects challenges in early diagnosis and access to effective treatment, particularly for conditions such as diabetes, where many cases remain undetected until complications arise.
Men are particularly underrepresented in healthcare management, often due to their role as primary earners. Their work responsibilities often leave them with little time for health facility visits. This issue is more pronounced in rural areas where illness is often viewed as a sign of weakness, leading many men to hide their symptoms to maintain an image of strength, thereby delaying crucial care.
Alvern Mutengerere, SolidarMed’s project manager, highlighted that in certain regions like Chikombedzi, the situation is exacerbated as men often migrate for informal work in South Africa, further restricting their access to NCD care.
The Chikombedzi Hospital’s diabetes support group was formed in response to these challenges.
'I realised that three-quarters of the time on our NCD days [when patients can come for follow-up at the hospital], the men were not actually turning up as advised', said Ruth Hlongwane, SolidarMed’s project assistant who facilitated this group.
'Another thing was that men were usually admitted in a bad state before their diabetes that would lead to NCD diagnosis – this is why I said, we need to deal specifically with men to improve their health-seeking behaviour'.
Because many men were worried about the lack of time, Ruth had to explain the advantages of organising themselves, considering their needs. They responded very well to that. 'Now, the group has 12 members. We set up a WhatsApp group, and we share most of the information in the chat. We use it even for follow-up days'.
Another challenge was related to diet and home management. A staple food in Zimbabwe is 'sadza', made from white maize, often consumed daily in large quantities. Understanding how portion control affects blood sugar is crucial for people living with diabetes.
Monitoring and the availability of medication were other issues faced by the members. 'There is a reason to smile when going to the hospital because you know your blood sugar will be checked, and you receive medication and information about diabetes complications,' explained Luckson.
Another member shared that, before the project, there were many cases of complications such as diabetic retinopathy, cataracts, and cases of amputation: 'Now we receive valuable education about foot care and managing complications.'
One essential goal of the WDF project in rural Zimbabwe is to boost health literacy among people with diabetes and their families. Trained healthcare professionals deliver comprehensive patient education sessions.
These sessions, supported by digital health applications and motivational text messages, cover all key aspects of diabetes management: diet planning, exercise, and foot care, and encourage self-care practices, proactive health behaviours, and equitable access to care.SolidarMed involved village health workers who have been trained in diabetes management.
'They also meet with members to educate them about diabetes care and remind them to come back to the hospital on time. It’s much easier, and we are working with those strategies very well', Ruth adds.
The group has become a valuable resource for other men with diabetes.
'You can only realise the importance of medication if you are educated', says one of the group members.
They all knew each other before the group was formed. Now, they meet monthly at each other’s homes to discuss personal matters, which helps to foster a sense of community and emotional well-being. They provide each other with advice on nutrition, medication, and lifestyle changes, which supports their self-management. Luckson reflected on this: 'If you are alone, it is painful. But if you have friends and colleagues, it is easier.'
The Chikombedzi support group actively promotes empowerment and acceptance, targeting men who tend to have a more relaxed attitude towards health-seeking behaviours, challenging the perception that a diagnosis equates to a shortened lifespan.
The members are dedicated to raising awareness in remote areas where such misconceptions can be particularly harmful to men living with diabetes. In August, they attended a local community outreach event and took this chance to talk about diabetes mellitus to the elderly men and local leaders. A village health worker was there to check everyone's blood sugar levels. Of the 51 men who agreed to be screened, three were found to be in a pre-diabetic state and were referred to the Chikombedzi Hospital for proper care. The village leaders were very thankful for the group’s efforts.
'We act like consultants because our friends and relatives tell us their symptoms. Then we advise them to visit the hospital.', Luckson adds. 'In other words, we are advancing SolidarMed’s mission'.
In low- and middle-income countries, sex and gender influence health literacy and outcomes. As mentioned earlier, men often delay seeking medical help due to societal pressures, a problem exacerbated in resource-limited countries.
Studies show that men in Southern Africa are more likely to withdraw from health services than women, leading to higher death rates. This disparity is expected to worsen with the increasing prevalence of NCDs and complex co-morbidities, as highlighted in a 2021 review of interventions for men’s health.
Despite these challenges, the Chikombedzi Hospital’s support group has found strength in unity.
'SolidarMed unites us', a group member shared. 'I felt like an alien from a distant planet. I was so lonely in a sea of people. Now we know each other, we know our homes, we share ideas and experiences in a relaxed atmosphere.'
Another member expressed gratitude for the WDF project because it provided him access to medication and the chance to be part of a group, helping him better manage his condition and receive psychosocial support in a community where diabetes is often misunderstood.
'You have given us the opportunity to tell our story and about diabetes to our relatives, friends, and all the locals', adds Luckson. 'People are opening up’.
So far, the SolidarMed team has observed good glycaemic control and improved health in seven of the Chikombedzi Hospital’s group members and aims to learn from the currently established groups before considering scaling them up in the next funding phase.
'This group is crucial to our clinic, the community, and men in general because they share their challenges and reassure newly diagnosed individuals that they are not alone and can manage the condition well', added Ruth.
Since many men, undiagnosed or stigmatised, still hold misconceptions about diabetes, working with local male champions living with the condition helps to dispel these myths and encourages others to get screened or learn how to manage diabetes.
Under the motto You are not alone, the group has great plans to extend their reach and decentralise the support group to be able to prepare, motivate, and encourage men with diabetes who lack access to education.
'We realise many are dying there. Some because of low self-esteem, others because of lack of information. That’s our mission, to inform and support', adds Luckson.
'Even when our Maker takes us, we would have left people with diabetes in a much better situation than it was. We leave a legacy.'