Table 1: The Zimbabwean Health-Care Referral System and Diabetes Care

Level Type of Institution Responsibilities

Primary level Rural clinic Manned by nurses and nurse aides.
Initial assessment of diabetic patients
No tdeatment
Cases are referred to secondary level
No facilities for inpatients.

Secondary level District hospital Treatment, monitoring, education of referred uncomplicated diabetic cases.
One or two doctors (mostly general practitioners)
Admission of patients.
Complicated cases are referred to level 3

Tertiary level Provincial hospital Continued management (treatment, monitoring, and education) of diabetics in diabetes clinics
Limited specialized doctors, general practitioners and nurses
More complicated cases are referred to level 4

Quaternary level Central hospitals and private-for- profit hospitals More specialist physicians in internal medicine, general practitioners and general nurses.
Diabetes clinics for management of patients with diabetes- related complications.
Patients are referred back either to level 2 or 3 when stable.