North West Province, 19-21 August 2015 - The WHO country office has been supporting the NDOH in developing and finalising the National Adherence Strategy on Chronic Diseases (HIV, TB & Non-Communicable Diseases (NCDs). The strategy has been finalised and will be reviewed by the National Health Council in September. It was thus decided to work on a pilot implementation of this strategy. To this end, it was decided that orientation training was needed in some sites. Four provinces were identified with sites and controls in each of these relevant districts.

The training involved approximately 30 participants from two sub districts of Bonjala, Rustenburg and Madibeng. Two trainers were present and two representatives from the NDOH attended. Day one focused on disease training, Day 2 on adherence counselling and Day 3 on monitoring and evaluation.

Day 1 was particularly intense, looking at clinical aspects of the diseases included in the National Adherence Strategy on Chronic Diseases. The knowledge on HIV and TB seemed to be fairly good, while knowledge on diabetes, hypertension and mental health was not as strong. It became apparent that further clarity and training on these aspects are required.

Day 2 continued with aspects of counselling and adherence. Counsellors face a great deal of challenges in their roles. There are also activities which are not necessarily part of their scope of work which they are becoming bogged down with. Therefore, their roles need to be outlined clearly in the training manuals. Role play was a fundamental part of the training. Challenges of workload were also identified.

Recommendations:

Training:

Clinicians should partake in training
Comprehensive training on NCDs, medications, side effects is required
Sett the context by beginning training with the NDOH presentation on the National Strategy
Training manual:

Include a section on counsellors’ rights, roles and responsibilities
Include an overarching section on NCDs in general, 4x4 table from WHO
Interrogate clinical aspects of diseases in more depth and modify as required in the manual
Modify training manuals to include some aspects of the legislation