Below are the citation, key messages and extracts of a new paper in Health Policy and Planning. The paper raises questions about the availability and use of healthcare information and knowledge. It draws attention to the know-do gap: the gap between what health workers know and what they do, and links this with ‘low motivation’, ‘lack of guidance’ and ‘no drive for providers to perform’.

CITATION: Perceptions on diabetes care provision among health providers in rural Tanzania: a qualitative study
Mary Mwangome, Eveline Geubbels, Paul Klatser and Marjolein Dieleman.
Health Policy Plan. (2016)
doi: 10.1093/heapol/czw143
http://heapol.oxfordjournals.org/content/early/2016/10/20/heapol.czw143.full?papetoc

Corresponding author: mmwangome@ihi.or.tz; mmwangome@gmail.com

KEY MESSAGES
– A know–do gap exists among providers regarding diabetes care provision.
– Self-management support to patients is limited and sometimes contradictory.
– Guidance for diabetes services at facility and district levels must be strengthened if diabetes services are to be provided according to the ICCC framework in this rural district.

EXTRACTS
‘over 60% of persons with diabetes in Tanzania do not know they have it (Kavishe et al. 2015)’

‘Whereas it has been shown in other Tanzanian settings that health workers lacked knowledge on diabetes care (Peck et al. 2014), health providers in our study seemed to have some knowledge of what was expected of them but did not practice according to that knowledge. Although providers gave reasons for not performing tasks, such as financial and geographical constraints for not tracking patients, there seemed to be minimal effort to improve the services in terms of patient referral, patient recording and patient education practices, especially at the district-hospital.

‘These observations point to a know–do gap, which has also been demonstrated among reproductive and child health service providers in Tanzanian and is thought to exist across Africa among health workers in general (Soucat and Scheffler 2013). The know–do gap is associated with low levels of motivation and professionalism (Leonard and Masatu 2010). Motivation of workers determines their performance and their performance determines the quality of services they deliver (Dussault and Dubois 2003). In our setting, low motivation and lack of guidance to providers could be possible factors contributing to the performance limitations as there was no drive for providers to perform. Improving human resources management and assuring guidance and support in diabetes care at facility level could address the know–do gap and improve performance of health providers in rural settings (Soucat and Scheffler 2013).’
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Best wishes, Neil

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