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Page 5 of 7 Original Research

Challenges faced by patients in accessing non- hypertension. For sugar [diabetes mellitus], I have never received
communicable diseases care and related coping medication from this clinic.’ (Male, 62 years old, participant with
mechanisms HTN and DM)

The analysis of data generated from the FGDs revealed the When they cannot get medication from the clinic, participants
non-availability of BP and RBS measurement services, the reported getting prescriptions to purchase the required
non-availability of HTN and DM medication at ART sites, the medication from private pharmacies, where the main
unaffordable cost of medication at private pharmacies and challenge is the high cost of medication and transportation:
the challenges of transportation costs when seeking medical
care or medication, as common challenges faced by patients ‘They give a prescription for you to buy in the [private]
in accessing care for HTN and DM. The saturation grid for pharmacies in town. There drugs are very expensive and some
of us cannot even afford them. To go there you need transport
themes and subthemes emerging from the FGDs is presented fare again. It’s really not easy.’ (Female, 68 years old, participant
in Table 4. The FGD findings at both urban and rural sites with diabetes mellitus)
were consistent with those from the key informant interviews.
Coping mechanisms
Challenges in accessing healthcare Common coping subthemes included taking multiple doses

There was consensus across all FGDs that BP and RBS to compensate for missed doses, sharing and rationing the
measurement services were not always available at all study medication. Furthermore, the use of home remedies,
sites. Participants pointed to repeated power cuts affecting traditional herbs and consultation of traditional and faith
the electric-powered BP machines, the battery-powered healers emerged as coping strategies to deal with the
machines running out of batteries or service non-availability identified challenges in managing HTN and DM.
because of use of the machine in other clinic departments:
It emerged that when patients do not have enough medication
‘…. As for me, my BP was only checked once this year. Most of
the time I come here there will be no electricity so the BP machine to last the whole month, there was a general consensus that
will not be working. Sometimes you come here, and you are told they ration the medication by only taking medication when
the machine is being used in the maternity ward. As for sugar they experience serious illness. Also reported was that
[diabetes mellitus], I don’t even know whether the machine is here patients often took multiple doses of HCT to complement the
or not because I have never received the service here.’ (Female, missing medication, which would not have been purchased,
55 years old, participant with HTN & DM) or when they perceive symptoms to be associated with their
hypertension:
The other commonly emerging subtheme from all FGDs was ‘You go to the clinic and they give you only HCT. Apart from
of medication availability for HTN and DM. Participants HCT, I need 3 more types of BP drugs. So when it gets serious, I
from all the ART sites confirmed that HCT is the only take 4 HCT pills at once to relieve the pain, and it works.’ (Male,
medication for HTN, which some might access. However, 57 years old, participant diagnosed with HTN 10 years ago)
some hypertensive patients are not prescribed HCT, while
others take more than one variety of medicine, none of which Others reported borrowing medications when they run out
can be accessed at the clinic. None of the patients from all the of medication:
12 FGDs reported to have accessed DM medication: ‘Last time I fell seriously ill and I could feel I was dying. I did
‘Sometimes they give HCT, but it is not everyone who gets it. not have the medication and transport fare to go to the clinic
Again, some of us do not take HCT, I take 4 other drugs for either. I ended up borrowing the medication from my

TABLE 4: Saturation grid of themes and subthemes emerging from focus group discussions.
Themes and subthemes Focus group discussion number
1 2 3 4 5 6 7 8 9 10 11 12
Challenges in accessing healthcare
• Non-availability of HTN screening x x x x x x x x x x x x
• Non-availability of RBS screening x x x x x x x x x x x x
• Non-availability of HTN medication x x x x x x x x x x x x
• Non-availability of DM medication x x x x x x x x x x x x
• Unaffordable cost of medication in private pharmacies x x x x x x x x x x x x
• Challenges with transport costs to seek medical care or medication x x x x x x x x x x x x
Coping strategies or mechanisms
• Taking multiple drugs to compensate missed doses x x x x x x x x x x x x
• Sharing medication with colleagues x x x x x x x x x x x x
• Rationing of medication x x x x x x x x x x x x
• Use of home remedies x x x x x x x x x x x x
• Use of traditional herbs x x x x x x x x x x x x
• Consultation of traditional or faith healers x x x x x x x x x x x x
DM, diabetes mellitus; HTN, hypertension; RBS, random blood sugar.

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