Access to Care
Despite the insurmountable cardiovascular risk burden, it is important to note that healthcare systems in many parts of Africa are designed to treat acute communicable diseases, rather than preventable NCDs [5] in part due to resources [22]. As a result, equity in terms of access to health care is constrained by the fact that patients with cardiovascular risk burden make significant demands on already scarce health resources.
The healthcare system in SSA is often challenged by lack of sufficient resources to provide adequate patient care. Both lack of institutional resources and up-to-date practical information for healthcare providers often jeopardizes patient care [99]. A review by Motala (2002) [100] noted that the increasing diabetes trends in Africa are influenced by inadequate health care infrastructure, inadequate supply of medications, and lack of available healthcare facilities and providers. Issues such as lack of protocols for diabetic complication evaluation and monitoring, little or non-existent referral systems, inadequate health facilities, and absence of multidisciplinary diabetic care teams also make diabetes care difficult [101].
Among diabetes patients in Mozambique and Zambia, patients in need of insulin were faced with the high cost of the medication when available but were also faced with lack of availability of insulin when needed [102]. Similarly, Whiting and colleagues (2003) [101] noted that the contextual, clinical, and health systems challenges to the delivery of health care for diabetes in Africa is influenced by several factors, including poor patient attendance at health clinics, short consultation time with physicians (leaving little or no time for patient education), inadequate staff, limited staff training, poor control of blood glucose and blood pressure, inadequate referral systems, and almost non-existent patient