Providers seemingly could not reconcile their empathy with their perception of dr-NCDs as a failure of prudence or responsibility by patients. While providers often had empathy and understanding of patients’ circumstances, their training and context had not equipped them to translate that understanding into a clinical context. The single dietician for the district was ill-equipped to connect dr-NCDs with the upstream determinants of health. A marked lack of connection between health and social services at the local level, and a shortage of dieticians, meant that doctors provided rapid, often anecdotal dietary advice. Health care practitioners focused primarily on patients’ individual responsibility to eat a healthy diet and adhere to treatment. They identified changing diet as an important factor driving diabetes and high blood pressure in particular. In particular, the rising prevalence of dr-NCDs alarmed providers. The perspectives of key informants within the public sector therefore offered insights into tensions and commonalities between individual, neighbourhood and health systems perspectives. We then conducted a thematic analysis of these interviews. In previous work, we had interviewed and conducted ethnographic research focused on dr-NCDs in the same neighbourhood. We interviewed eight key informants who were central to the primary care service for at least 40,000 people living in a low-income neighbourhood of Cape Town, South Africa. In this article, we investigate the experiences of eight key informants within the public sector health care system (nurse, doctor and dietician), in order to reflect on their experiences treating dr-NCDs. In South Africa, diet-related non-communicable diseases (dr-NCDs) place a significant burden on individuals, households and the health system.
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