Measuring healthcare quality in police custody: the development of quality indicators through expert consultations in the Netherlands.

The high burden of chronic communicable diseases, such as human immunodeficiency virus (HIV) infection, and the escalating rise of non-communicable diseases (NCDs) in South Africa and other sub-Saharan African countries, calls for a shift in how healthcare services are designed and delivered. The shift is towards empowering people to take greater responsibility for their health and to manage their chronic disease. Chronic diseases tend to be of a longer duration and result from an interplay of genetic, physiological, environmental and behavioural risk factors. To provide better care for individuals with chronic comorbid diseases, the South African Department of Health (DoH) implemented the Integrated Chronic Disease Management (ICDM) model in 2011 for Primary Health Care (PHC). The chronic diseases included in the ICDM are hypertension, HIV, diabetes, asthma, epilepsy, chronic obstructive pulmonary disease (COPD), tuberculosis and mental health illness. The ICDM model focuses on enhancing healthcare service delivery through facility reorganisation, clinical support, supported self-management and community-based support systems to provide efficient, patient-centred care. The overall aim of the ICDM is to provide integrated prevention, treatment and care for persons living with chronic diseases at the PHC level, to ensure the transition to assisted self-management within the community and achieve good outcomes for patients using the health system building blocks. These building blocks include service delivery, health workforce, health information systems, access to critical medications and technological resources, health financing, and leadership and governance. The ICDM model further recognises that most persons (70% – 80%) with chronic diseases can be managed in the community through self-management support. Self-management is described as a process by which individuals and families of persons living with chronic disease use knowledge and beliefs, self-regulation skills and abilities and social facilitation to improve their health outcomes. It takes place in the context of risk and protective factors specific to the condition, the physical and social environment, and the individual and family. Self-management for people with chronic diseases refers to the ability to manage their own symptoms, treatment, physical and psychosocial effects, and lifestyle adjustments that come with having a long-term disease. It includes responsibilities such as symptom monitoring, medication adherence, implementing essential lifestyle adjustments (such as eating healthy food, frequent physical activity and smoking cessation) and dealing with the emotional impact of chronic illness. For example, a person with diabetes may check their blood sugar levels regularly, adjust their diet, and take insulin as prescribed, whereas an asthmatic may avoid known triggers and use an inhaler correctly during flare-ups.