1. Respect for Patient Preferences and Values: PCC starts with respecting the patient’s individual preferences, needs, and values. In sub-Saharan Africa, this means acknowledging the diversity of cultural practices, religious beliefs, and social norms that influence health behaviours. Doctors should engage patients in conversations that respect these factors, ensuring that care plans align with the patient’s lifestyle and beliefs.

2. Coordination and Integration of Care: Given the fragmented nature of many healthcare systems in sub-Saharan Africa, coordination of care is crucial. PCC involves ensuring that all aspects of a patient’s care—whether it involves multiple healthcare providers, traditional healers, or community health workers—are well-coordinated and integrated to avoid gaps or overlaps in care.

3. Communication and Education: Effective communication is at the heart of PCC. In sub-Saharan Africa, where literacy levels vary and multiple languages are spoken, doctors must ensure that communication is clear, culturally appropriate, and in a language the patient understands. This may involve using visual aids, translators, or community health workers to bridge language and literacy gaps.

Educating patients about their health conditions in a way that empowers them to take an active role in their care is also essential. Training community health workers and nurses and using them to give health education about chronic diseases in local dialects to patients before consultations could improve health literacy and autonomy.

4. Physical and Emotional Support: Providing care that addresses both the physical and emotional needs of patients is key to PCC. In regions where mental health services are scarce, doctors should be aware of the psychological impact of chronic diseases and provide support or referrals when necessary. Additionally, ensuring that patients have access to necessities, such as transportation to medical appointments or financial support for medications, is part of a holistic care approach.

5. Involvement of Family and Community: In many sub-Saharan African cultures, health is seen as a communal responsibility rather than an individual one. PCC should therefore involve family members and community leaders in the care process. This not only helps in understanding the patient’s context better but also ensures that the patient has a support system that reinforces healthy behaviours and adherence to treatment.

6. Access to Care: In sub-Saharan Africa, geographic, financial, and social barriers can limit access to healthcare. PCC involves advocating for and facilitating access to care, whether through mobile clinics, telemedicine, community outreach programs, or partnerships with non-governmental organizations (NGOs). Ensuring that care is accessible and equitable is a fundamental aspect of PCC.

1. Resource Constraints: One of the biggest challenges in implementing PCC in sub-Saharan Africa is the limited healthcare resources. Doctors must often work with minimal staff, outdated equipment, and insufficient supplies. PCC in this context requires creativity and flexibility, such as leveraging community health workers to extend care into remote areas or using technology to overcome distance barriers.
2. Cultural Sensitivity: The cultural diversity of sub-Saharan Africa means that PCC must be highly adaptable. Doctors need to be trained not only in clinical skills but also in cultural competence, understanding the varied beliefs and practices that influence health in different communities. This may involve collaborating with traditional healers or incorporating culturally significant practices into care plans.
3. Health Literacy: Low levels of health literacy can be a barrier to effective PCC. In sub-Saharan Africa, where education levels may vary widely, doctors must ensure that health information is presented in a way that is accessible to all patients. This might involve simplifying medical terminology, using visual aids, or conducting group education sessions that allow for peer learning.

4. Patient Autonomy vs. Collective Decision-Making: In many African societies, health decisions are often made collectively within families or communities. While PCC emphasizes patient autonomy, doctors must balance this with respect for collective decision-making processes. Engaging family members and community leaders in the care process can help align individual care with broader social and cultural expectations.

1. Training and Capacity Building: Healthcare providers and medical students need ongoing training in the principles and practices of PCC, including communication skills, cultural competence, and the use of low-cost, high-impact interventions that can be adapted to resource-limited settings.
2. Healthcare System Support: For PCC to be effectively implemented, healthcare systems need to support it through policies that prioritize patient engagement, integrated care models, and community-based health initiatives. Governments and NGOs should work together to create environments where PCC can thrive.

3. Patient and Community Engagement: PCC requires active involvement from patients and their communities. This can be fostered through health education programs, community health forums, and the inclusion of patients in decision-making processes about their care. Socio-economic empowerment of the population correlates positively with improvement in most of the indices associated with good health.

Context: A 50-year-old man named Mr. M, living in a rural area of sub-Saharan Africa, has been diagnosed with hypertension. He struggles with medication adherence and dietary changes due to financial constraints, limited understanding of his condition, and the influence of local community beliefs about health. The doctor uses a patient-centred approach to understand and address his challenges.

Doctor: “Good morning, Mr. M. It’s nice to see you again. How have you been since our last visit?”

Mr. M: “Good morning, Doctor. I’ve been managing, but honestly, it’s been difficult. The medicine is expensive, and I’m not sure if it’s really helping. Plus, people in my village say that the herbs from the bush are better for controlling blood pressure.”

Doctor: “Thank you for sharing that with me. I can see that this situation is challenging for you, especially with the cost of medication and the advice from your community. Let’s talk about each of these concerns so that we can find a plan that works for you. Would that be, okay?”

Mr. M: “Yes, that would be helpful, Doctor.”

Doctor: “Let’s start with the medication. I understand that it’s expensive. Have you had difficulty buying it regularly?”

Mr. M: “Yes, sometimes I can’t afford it, so I skip doses or take it less often. I also feel like it’s not making a big difference, so I wonder if it’s worth the cost.”

Doctor: “It’s important that you’re honest about this, and I appreciate that. Skipping doses can make it harder to control your blood pressure, which can lead to serious problems like stroke or heart disease. But I understand that the cost is a big concern. Let’s see if we can find a more affordable option. There are different types of blood pressure medications, and some are less expensive. I can also refer you to a community health program that might be able to help with the costs. How does that sound?”

Mr. M: “If there’s a cheaper option, that would be great. I didn’t know there were different kinds of medicines”.

Doctor: “Yes, there are a few options, and we’ll work together to find one that fits your budget and still helps control your blood pressure. Now, let’s talk about the herbs that people in your village have recommended. I know that traditional medicine is very important in your community. Have you tried any of these herbs?”

Mr. M: “I’ve tried some teas made from leaves that people say are good for the heart, but I’m not sure if they’re really helping. My neighbour swears by them, though.”

Doctor: “It’s good that you’re open to different treatments. We need to be careful that they don’t interfere with your medication or cause organ damage.”

Mr. M: “You have a point doctor; I heard also of someone who used herbals that damaged his liver”

Doctor: “Yes, damages to liver and kidneys occur frequently. I also want to help you understand more about hypertension—what it is, why it’s important to manage, and how you can control it with both medication and lifestyle changes. Would it be helpful if I explained a bit more about this?”

Mr. M: “Yes, please. I know it’s about the blood pressure, but I don’t really understand why it’s such a big deal.”

Doctor: “Hypertension is when your blood pressure is consistently too high, which makes your heart work harder. Over time, this can damage your blood vessels and lead to serious health problems, like heart attacks or strokes. But the good news is that we can manage it with medication, diet, and other lifestyle changes. Simple things like reducing salt in your food, staying active, sleeping well and managing stress can make a big difference. Does that make sense?”

Mr. M: “Yes, I understand better now. I didn’t realize it was so serious.”

Doctor: “I’m glad we could talk about it. Let’s set some goals together. We’ll find a more affordable medication and make some small changes to your diet. I can also give you some tips on how to reduce salt in your meals without losing flavour. How does that sound?”

Mr. M: “That sounds good, Doctor. I’ll try to follow the advice.”

Doctor: “Great. I’m here to support you, Mr. M. We’ll take it step by step. If you have any questions or run into any problems, don’t hesitate to reach out before your next visit. Let’s work together to keep your blood pressure under control. Take care, and I’ll see you soon.”

Mr. M: “Thank you, Doctor. I feel more confident now.”

In this example, the doctor uses a patient-centred approach to address Mr. M’s concerns about managing his hypertension. By listening to his financial worries, acknowledging the influence of traditional medicine, and explaining the condition in simple terms, the doctor helps Mr. M feel more informed and supported. The doctor also works with Mr. M to find practical solutions, such as exploring more affordable medication options and lifestyle modifications. This approach not only enhances Mr. M’s understanding and adherence but also respects his cultural context and financial limitations.