The aim of the project is to strengthen the capacity for diabetes care in the Mara, Kagera and Shinyanga regions in Northern Tanzania.
Expected impact
Diabetes and risk factor prevalence data provided based on the WHO STEPs approach
85 existing health facilities strengthened to provide diabetes care in the three regions
340 health personnel trained in basic and advanced diabetes care
25 clinical officers and nurses trained on nutritional management of diabetes and overweight
Access to improved care through primary level for an estimated number of 122,000 people with diabetes
2.5-3 million people exposed to awareness campaign
Results to date
The diabetes and risk factor prevalence survey has been conducted in Mwanza and Kigoma Region.
88 diabetes clinics have been established in four regions of the Lake Zone (Kagera (36), Shinyanga (22), Mara (23) and Mwanza (2)), having improved the level of diabetes care substantially mainly at the primary health care level in rural areas. All clinics have been equipped with a starter kit and educational posters.
334 health care providers (85 doctors, 163 nurses and 86 lab technicians) have been trained. Refresher courses are scheduled.
Doctors and nurses have spoken on several radio and TV programs and the printed media has had several articles on diabetes.
Community screenings were conducted during the World Diabetes Day. Community awareness activities are ongoing.
The Tanzania Diabetes Association (TDA) office is now fully equipped and operational. The office is staffed with a project manager, an accountant, a community liaison officer, a nutritionist and an office attendant.
Project details
Diabetes care at regional level has been significantly strengthened with diabetes clinics established in 25 out of Tanzania's 26 regions with WDF support since 2003.
At district level, however, health facilities remain ill-equipped to diagnose and provide basic care for diabetes.
As a result, diagnosis rates remain low, late diagnosis is frequent, the level of complications is high and patients have to travel long distances to access care.
As proper care is unavailable at primary level, the secondary and tertiary levels of care are overcrowded and often providing basic care, when they should be focusing on the more complicated cases. Hence, there is a need to strengthen the access to care at the appropriate health care level and to establish an effective referral system.
Objective
The aim of the project is to strengthen the capacity for diabetes care in the Mara, Kagera and Shinyanga regions in Northern Tanzania.
Approach
The Regional Medical Officers and the District Medical Officers in the Mara, Kagera and Shinyanga regions in Northern Tanzania have identified strengthening of the capacity of diabetes care as a key priority area and consequently have requested the assistance of the Tanzania Diabetes Association.
The project is funded by DANIDA and WDF.
The project seeks to implement a holistic and cost-effective model for enhancing the quality of diabetes care from primary to tertiary level and raising public awareness of diabetes, its risk factors and prevention. The model is presently being implemented in Mwanza Region under the WDF and DANIDA funded project "Strengthening referral system" WDF05-102.
The project builds on the approach developed by the Tanzania Diabetes Association and experience gained during the implementation of WDF-funded "Access to Care" WDF02-031. It builds on these established structures, while at the same time strengthening the system further by:
Determining baseline prevalence data to provide policy makers with appropriate data for efficient planning and budgeting using the WHO STEPs approach
Bringing diabetes care to the primary care level and strengthening secondary and tertiary levels
Introducing nutrition counselling in the clinics through a targeted nutrition course for clinical officers and nurses with the purpose of increasing capacity in the health care system to provide appropriate advice and counselling to people with diabetes and at-risk groups
Establishing an appropriate and effective referral system from primary over secondary to tertiary level
Strengthening community awareness and involvement in the process to enable early diagnosis and prevention of diabetes and its complications
In each of the districts, diabetes clinics for early diagnosis and basic diabetes care are established at the existing main district health facility. The clinics are provided with equipment kits.
In each primary level clinic, five health care personnel - two assistant medical officers, two nurses and one laboratory technician - will be trained in diagnosis and basic treatment of diabetes, foot care and patient and public education.
In recognition of the fact that the Tanzania health care system traditionally has been geared towards addressing under-nutrition whereas over-nutrition has been a neglected area, a focus on nutrition is included as a new item in the approach. Therefore, a minimum of 25 clinical officers and nurses will be trained in nutritional management of diabetes and overweight.
The training course consist of two sessions; the first round of 4-day training is held within the first 2-5 months and the second round takes place after 10-14 months. The trained health care personnel will be identified from the existing staff in the targeted health care facilities.
As part of the project, referral pathways and guidelines will be discussed and strengthened to ensure optimal use of each level of the health care system.
Finally, a community awareness campaign is included to raise awareness of diabetes, its symptoms, risk factors and complications, and to encourage people to attend the diabetes clinics in order to increase early diagnosis and proper care and to instil lifestyle modifications. The campaign will be implemented in the form of community meetings, posters, leaflets, exhibitions and radio programmes and spots.
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