Building capacity - reducing diabetes complications

Objective

The project seeks to improve the quality, accessibility and effectiveness of diabetes care and thereby reduce the burden of diabetes complications in Nauru and Vanuatu.

Expected impact

• The project is expected to benefit at least 30% of all people with known diabetes in Vanuatu and Nauru through improved diabetes care
• At least 50% of all health care providers in Vanuatu and Nauru will benefit through training, improved standards and guidelines and access to continuing professional education and support

Results at project completion

Nauru

• A diabetes centre has been established and operates as a one-stop-shop for people with diabetes. Routine check-ups and medication reviews are provided, and patients can have their medications dispensed at the centre. Foot dressings are available along with patient education regarding smoking, physical activity and nutrition. Transportation is provided, assisting patients to get to and from the centre. 528 patients are registered.
• 5 diabetes team members (nurses) from the diabetes centre have undergone 2 weeks training in Australia. Additionally, 22 public health staff and 13 primary health care workers have undergone a 2-3 days diabetes training workshop.  
• As of September 2008, routine visits to eight districts have been established, focusing on diabetes education and providing some basic clinical testing.
• A Diabetes Kit has been given to the Nauru Diabetes Centre and it has been equipped with a DCA Analyser and an LDX Analyser for future complication screenings. Staff has been trained to operate the equipment.
• In-country staff in Nauru is establishing a diabetes association and is in the process of applying for membership to the International Diabetes Federation (IDF).
• A national weight reduction campaign titled “Stomp the Fat” has run, encouraging people to do physical activity.

Vanuatu

• A diabetes centre has been opened in Vila Central Hospital in Vanuatu with plans for establishing a national NCD centre. 652 patients are registered.
• 3 diabetes team members (doctor, nurse and project support officer) have undergone 2 weeks training in Australia.
• 10 diabetes training workshops have been held for a total of 124 health workers. 
• Diabetes Clinic Kits have been distributed to the six regional health centres throughout Vanuatu, and 2 DCA analysers made available at the two national referral hospitals and 1 LDX analyser at Vila Central Hospital. 
• The Diabetes Association of Vanuatu has been formed and has achieved a full membership of the International Diabetes Federation (IDF).
• Health education material on general diabetes care and foot care has been distributed to all provinces.

Project details

The burden of preventable diabetes complications in Pacific Island countries is disproportionally high. It results in untold personal suffering as well as untenable financial costs to the countries. Diabetes prevalence is expected to be between 12 and 20 % of the adult population. With their relatively small populations, Nauru and Vanuatu are unable to support the required specialist health care services. As a result, experts have to be brought in from abroad or patients have to be sent to Australia or New Zealand at a high cost. Approach This project centres on secondary and tertiary prevention of diabetes complications through service and systems development and capacity building with particular emphasis on primary care and referral networks. The aim is to design and implement a locally relevant and sustainable model to increase the capacity of Nauru and Vanuatu to manage, monitor and improve diabetes care and reduce eye, kidney and foot complications resulting from diabetes. In addition to building the specialist capacity in the area of diabetes complications, the idea is that building effective systems for appropriate diabetes care and management, many people with diabetes may avoid developing complications. The project design and workflow will follow a "Measure the status quo - Develop the model - Make a difference - Measure the difference"-method. As a first stage, the existing level of diabetes care and services will be assessed in the two countries. This will be followed by a process of developing a suitable model, based on internationally recommended standards of care and targeted at delivering optimally effective diabetes care that is locally relevant and feasible in a Pacific Islands setting. Implementation - making a difference - will focus on introducing the systems identified, equipping the services and training the health care staff in areas of clinical management, patient education and services management. This stage will also focus on maintenance and monitoring of the systems, including review and adjustment to ensure consolidation of an appropriate and effective model. At the end of the project the baseline assessment will be repeated in order to measure the difference made by the project activities. A number of institutions have agreed to contribute towards implementation of this project. These include the Ministries of Health in Nauru and Vanuatu respectively, the International Centre for Eyecare Education, the Australian and New Zealand Society of Nephrologists and the Diabetes Unit - Australian Health Policy Institute. The international institutions donate staff-time and clinical attachments in Australia to train health care staff from the two target countries. Furthermore, Novo Nordisk staff in Japan are co-funding the project.

This page was last updated 1-26-2011 by wdf.pia