The project seeks to develop a sustainable model for quality and affordable diabetes care within the Cambodian public health system and to explore preventive strategies.
Expected impact
Diabetes/hypertension clinics established in 5 provincial hospitals: Kampong Cham, Battambang, Prey Veng, Pursat and Kampong Thom providing quality and effective care for people with diabetes
An estimated 38,947 patients with diabetes will have direct access to diabetes care at the clinics
An estimated 116,526 people with diabetes from surrounding districts in the five provinces will also benefit from improved diabetes care
30-35 doctors and nurses trained by IDF under project WDF05-125 will work in the established clinics and receive continuous in-service training
30-40 health care staff in each provincial hospital will be trained through in-service training on diabetes and diabetic foot care
100 health centre staff in each province will be trained on diabetes care, screening and high-risk assessment
National standards of care, guidelines and standardized data management system will be established
Results to date
8 diabetes clinics have been established with referral hospitals in seven provinces (Battambang, Kampong Thom, Kampong Cham, Prey Veng, Pursat, Siem Reap, Kratie and Soth Nikum).
A total of 8,068 patients registered are registered in these clinics.
A total of 2,476 new cases of diabetes have been found at the clinics and 10,746 follow-up cases consulted.
370 health care providers from district health care centres in the vicinity of the established clinics have been trained.
682 village chiefs, health volunteers, people from women associations and commune council have attended awareness sessions at the nearby health centres.
A treatment guideline for diabetes and hypertension has been drafted and is being used in the clinics.
A comprehensive computerised record keeping system has been developed and is being used daily in all eight established clinics.
Project details
2004 and 2005 prevalence surveys in Cambodia have demonstrated that in urban areas approximately 10% of adults have diabetes. 25-35% of adults suffer from high blood pressure.
In a poor rural community surveyed in Siem Reap, 5% of adults had diabetes and 12% were hypertensive. Two thirds of those diagnosed with diabetes were unaware of the condition.
Currently there are limited services for diabetes care in Cambodia. Those that exist are primarily in the capital city, Phnom Penh. Most patients in the provinces - if they are aware of their condition - seek care from traditional healers, private practitioners or travel to Phnom Penh.
In addition, the public health service in Cambodia is almost entirely geared towards treating acute illnesses with very little provision for managing chronic diseases. There is no framework for structured outpatient care by physicians at a referral hospital level for patients with non-communicable diseases (NCDs), such as diabetes and heart diseases.
It is hoped that this project could provide a model for the establishment of outpatient care, which could be rolled out to other provinces and eventually expanded to cover other NCDs.
Approach
The project is implemented by the Ministry of Health in close collaboration with the Cambodian Diabetes Association and WHO.
Diabetes services will be established in the provincial referral hospitals of five provinces; Kampong Cham, Battambang, Prey Veng, Pursat and Kampong Thom.
There are 24 provinces in Cambodia and these five provinces are some of the largest outside Phnom Penh and they have currently no existing diabetes care services.
The diabetes care services will be integrated into the existing government health care system including staff and facilities, laboratory and essential medicines.
Due to space constraints in the provincial hospitals, the two clinics in Battambang and Kampong Thom will be in the form of containers, refurbished on site to function as clinics. These clinics are funded through a separate WDF fundraising project. The three remaining clinics will use the existing hospital facilities and buildings.
Medical and nursing staff in the pilot clinics, associated hospitals and health centres receives training and are involved in a continuous, in-service education programme on diabetes care and management.
Emphasis is also placed on diabetes self-management and exploring creative ways such as peer education to enable patients to care for themselves and decrease cost of health services.
Educators are trained over the two-year project period in order to create a model for self management training for patients and to create patient education materials:
During the first year, educators will develop their skills based on the training they receive through an International Diabetes Federation (IDF) training course (WDF05-125) also funded by WDF. Each nurse will initially undergo 4 weeks intensive training and then receive ongoing training onsite.
During the second year interested educators, together with peer educators and patient representatives will form a working group to design a pilot patient education material and modules for training patients in self management.
The Cambodian Diabetes Association will work towards identifying sustainable strategies for continuous availability of diabetes medication in all target provinces at an affordable cost to the patient. At present, medication is hardly available and not affordable.
Local branches of the Cambodian Diabetes Association will be established in connection with the diabetes clinics at the provincial hospitals.
Based on a review and revision of the framework used in the five pilot provinces, the project will develop a strategy and model for rolling services out to other referral hospitals.
The project operates alongside the National Non-communicable Disease strategy to promote reduction of NCD risk factors including poor diet, physical inactivity and smoking. This will include the pilot of an adult health check programme at 10 health centres, incorporating assessment and management of those at high risk for NCD.
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