Supplying solutions: A mixed-methods study on experiences with access to diabetes care supplies in four African countries to inform the development of a bundled solution for improved self-care and clinical management

Background: Consistent access to high-quality medicines and affordable health products remains a persistent challenge for people living with diabetes (PLWD) in low- and middle-income countries. PLWD lack access to essential commodities to prevent diabetes-related complications, face catastrophic out-of-pocket costs, are often unable to monitor their blood sugar, may ration medication and reuse syringes, and have limited access to diabetes education. This publication presents findings from a mixed-methods landscape assessment and retail outlet survey conducted between 2022 and 2024 in Mali, Mozambique, Tanzania, and Uganda to understand diabetes self-care and management practices, barriers to and facilitators of care, retail costs, and access to medicines and supplies. The results of the study informed a human-centered design process to develop a prototype diabetes self-care kit called the “Diabetes CarePak.” Methods: The study team conducted semi-structured in-depth interviews and focus groups with PLWD, health care workers, and stakeholders in Mali, Mozambique, Tanzania, and Uganda to assess key issues related to diabetes self-care and disease management. The study included a retail outlet survey of 150 public and private outlets across the four countries to examine the pricing and stock levels of essential supplies. Subsequently, human-centered design approaches were used in cocreation workshops with end users in each country to develop a prototype kit of diabetes management supplies and educational and health care worker training materials. Results: Study findings underscore significant barriers to access to and affordability of essential diabetes care supplies, including the unavailability of blood glucose testing even at local health clinics, low ownership of glucometers, difficulty finding brand-matched test strips, and inconsistent stock and high costs of diabetes supplies in pharmacies and retail outlets. Financial hardship and food insecurity impeded individuals’ ability to monitor glucose, adhere to medication, seek care at health facilities, and follow nutritional guidance. Conclusions: This study documented key diabetes self-care challenges, highlighted the advantages and desirability of a bundled solution, and employed a human-centered design to develop the CarePak prototype.