The project aims to improve access to care and quality of care for people with diabetes in Uganda
Expected impact
80 health care workers trained in diabetes prevention, diagnosis and care and provided with basic clinical tools for diabetes care
20 diabetes clinics operational
Referral system established and guidelines for referral of diabetes patients developed
Approximately 96,000 diabetes patients educated annually
Results to date
80 health care workers have been trained in diagnosis, treatment, monitoring and prevention of diabetes.
The trained health care workers have been provided with basic clinical tools for diabetic care (weight scale, height meter, blood pressure machine, Snellen’s eye cart, register, monofilaments, blood glues meter, blood sugar strips, urine strips, stethoscope).
20 diabetes clinics have opened and are operational. All clinics have been provided with direct support supervision from the project responsible to assess operations, needs and challenges.
IDF Africa guidelines for management of type 2 diabetes were distributed to all the hospitals.
From the opening of the 20 diabetic clinics in March 2008 to February 2009, a total of 7,632 patients with diabetes had been registered in the hospitals. Group education is done in the general out patient area of the hospitals so that the education messages given are also picked up by other patients in the area.
A referral system has been established in which the nursing officers assess the patients and decide which patients they can handle and which patients to refer to a clinical officer. The clinical officer does the same and only refers the most complicated cases to the medical officer or physician. All diabetes patients seen in different departments of the hospitals are referred to the trained diabetes team.
In hospitals with no medical officer, physician or facilities to handle particular patients, referrals to the nearest higher level of health care (district, regional or national referral hospital) are made.
A weekly radio diabetes education programme was broadcasted during four weeks at the local Kampala radio station. In addition, several education talks were done by senior staff in diabetes management at the Uganda Television channel. Local media have publicized the project in newspapers, radio and television.
Project details
At present diabetes is managed mainly in tertiary and few secondary health care facilities in Uganda - leaving a majority of diabetes patients without access to qualified care.
Infectious diseases such as malaria, tuberculosis, HIV/AIDS and other febrile illnesses are major causes of morbidity and mortality in Uganda. However, non-communicable diseases (NCDs) including hypertension, diabetes mellitus and cardiovascular disease are also important causes of illness and death in the Ugandan population.
Improved control of infectious diseases and longer life expectancy result in an increased burden of morbidity and mortality related to NCDs, affecting especially the productive age groups of the country.
Diabetes - and its related complications - represents one of the most important NCDs. However, trained manpower, equipment and drugs for treating diabetes are not available in most secondary and primary health care facilities, which mean that people with diabetes must travel long distances to receive the advice and treatment they need.
As a result, a large number of patients with diabetes and other NCDs remain unattended.
Approach
The project draws upon the diabetes clinic model developed by the Tanzanian Diabetes Association (WDF02-031 and WDF05-102).
Partners in the project include the Ministry of Health with the overall responsibility for the clinics, Uganda's Diabetes Association organising patients and the Tropical Health and Education Trust (THET) which is involved in training of the clinic staff.
Activities are targeted at establishing diabetes care in 20 health facilities, covering 10 districts in Uganda. 80 health care workers from the participating health facilities are trained in diagnosis, treatment, monitoring and prevention of diabetes.
The trained health care workers are provided with basic equipment for diabetes care, enabling them to open and manage basic self-sustaining diabetes clinics within their existing health care settings. Ministry of Health and the participating health facilities provide all staff, space and running cost for the clinics and as such the clinics are fully integrated into the existing health sector set-up.
Guidelines for referral of diabetes patients are developed and distributed to the health units to establish and promote an effective referral system for people with diabetes.
Upon establishment of the clinics, the project supervisory team at Mulago Hospital in Kampala continues to coach the clinics for a 1-year period to ensure the quality of care being provided.
At each clinic session, the diabetes patients and their relatives are taught prevention and control of diabetes and its complications. It is estimated that 96,000 patients will attend the clinics each year, accompanied by at least one relative, adding up to 192,000 people directly educated each year.
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