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The Fiji Ministry of Health has established that approximately 80% of admissions to surgical wards and the same percentage of surgical operations are related to diabetes. 300 diabetes patients undergo amputations every year.
In Fiji, the prevalence of diabetes for adults between 25-64 years is 16% with significant predominance in Indo-Fijians (24%) as compared to Fijians (11%) and urban (25%) compared to rural (13%) dwellers.
A lack of knowledge about diabetes among people living with diabetes may be attributed to the poor knowledge and communication skills of many health professionals who are the main health educators in Fiji.
Some health professionals provide a reasonable level of education, but their messages are not standardised. In addition, a reluctance to seek timely treatment amongst the indigenous Fijians can also be a contributing factor to the development of diabetes-related complications.
Approach
The project strengthens the currently existing diabetes and foot care services in Fiji. Public communication on non-communicable diseases (NCDs), diabetes education training, foot care services, and home-based care have all been piloted in recent years. This project integrates these various components and takes them to scale.
Two existing clinics will be refurbished and one clinic will be established in the Northern Division of the country.
A team of 6 Master Trainers will be trained to conduct a series of regular diabetes training workshops for doctors, nurses and community health workers, targeting 2 staff members from each of the 19 sub-divisions, totalling 38 health care personnel.
Supported by the 6 Master Trainers, these 38 staff members will then conduct their own training in the sub-divisions with the aim of training 125 out of 150 doctors, 1,000 out of 2,000 nurses and 2,000 out of 5,000 community health workers.
In addition, specific training on foot care is provided for a nurse and a nurse practitioner from each division through attachment with Royal Prince Alfred Hospital in Sydney. As well as diabetes education trainers, these staff members will become foot care trainers for their respective divisions.
Maintaining and strengthening the linkage between hospital care, the home and the next visit to the clinic is crucial in diabetes and foot care services. The home-based and outreach programme form another major component of the project to improve treatment compliance and outcomes.
Throughout the project, an integrated communication plan will be implemented, focusing on two key behavioural outcomes: "Check the feet" and "Go to clinic". This specific diabetes awareness campaign is part of a much larger NCD prevention programme supported by the Ministry of Health. | 
