Lessons learnt in a Nepalese project

In Nepal, a team completing their project in 2006 reflects back on what worked and what did not - and why!

Projects supported by the World Diabetes Foundation (WDF) typically run a few years, during which the activities are expected to have an instant impact on people living with diabetes and the level of diabetes care available. But most importantly the project must show an element of sustainability, securing a long term impact.

Short and long term effects

The aim for WDF is to alleviate the suffering of people living with diabetes in the developing world. WDF supports a variety of projects, some designed to help immediately like projects that detect diabetes and its complications, enabling those affected to receive instant treatment.

Other projects have a more long term perspective; educating people with diabetes and their families in managing the disease to prevent the development of complications. Others focus on awareness building to prevent people from developing type 2 diabetes.

The Nepalese experience

One of the 15 projects that have been completed to date is the “Diabetes prevention and education”-project run by Astha Nepal, a non governmental organisation formed by a group of like-minded health care professionals and lay people with the aim to promote awareness and encourage local communities to be pro-active to reduce the burden of chronic diseases.

The project aimed to create public awareness, advocacy and access to diabetes care amongst the poor population with previously limited access and information.

Insulin self-injection techniques was one of many topics discussed in diabetes camps.

The following activities were carried out from October 2003 to December 2006:

• Establishment and training of 18 local community teams to conduct community education and awareness camps, including training of 19 doctors, 27 other health care personnel and 60 social workers in diabetes detection and risk factor assessment
• 123 doctors and paramedics trained in diabetes detection and care by a central team.
• Full day diabetes camps in the communities and follow up camps at regular intervals. All in all 98 diabetes camps were organised where a total of 3,326 people received thorough check up of their diabetes status and practical self care education
• 448 people attended awareness classes on diabetes and 3,449 received information about diabetes at three diabetes exhibitions and four awareness camps for Rotarians, college students and general public
• Four out of 18 planned diabetes clubs have been formed
• Awareness spread through participation in television and radio interviews on diabetes. Articles on diabetes have been published in newspapers, souvenirs, monthly magazines and bulletins

Greater focus on diabetes achieved

Apart from educating people with diabetes, these activities resulted in attention being drawn to diabetes within organisations and the public system.

Other clubs and organisations have conducted diabetes camps using the methodology/materials developed during the project.

The Teaching Hospital in Dharan (BPKIHS) has taken the material to start community diabetes education awareness in their region, and The Ministry of Health and World Health Organization (WHO) have started a study on the prevelance of risk factors for non-communicable diseases involving Astha Nepal.

Another outcome noted by the project responsible Dr. Shrestha is the fact that prevention elements of diabetes in children is more spoken about in families amongst those who have been educated by Astha Nepal.

Dr Shrestha has experienced that doctors are more aware of the international guidelines in managing diabetes and its complications.

“The fact that WHO is initiating action on diabetes care and non-communicable diseases in a country like Nepal is evidence enough to support that the problem has been noticed. The fact that our project partner was asked to write a chapter in school text book about the effects of poor lifestyle on future health also suggests a lasting impact” says Dr. Anil Kapur, Managing Director of the World Diabetes Foundation.

Problems encountered

Dr. Shrestha explains that his team has reached many of the projected goals but has also encountered some difficulties. Political and social disturbances and unrest during the period made it difficult to carry out public camps and exhibitions.

Some people with diabetes and their families showed lack of motivation to attend the repeated one day meetings, which could be explained due to the costs of skipping work to attend the session. Dr. Shrestha suggests that shorter education sessions could have been a possible solution.

Some health care personnel as well as volunteers from the communities also showed lack of motivation, a problem that could have been met by selecting and screening the members more proactively, and again arranging awareness events of shorter durations.

Some sustainability expected

Dr Shrestha regrets that only four out of 18 expected diabetes clubs could be formed, although a few other clubs are in the process.

“The level of commitment to continue activities is high in those communities who have formed clubs and they are continuing the activities. In other communities the inability to form diabetes clubs and instability of trained manpower, the long term sustainability is likely to be low, ” he says.

The project team feels that if the people in the local community teams were given financial motivation the program could have been more sustainable. “Because of very low salaries, poor infrastructure and the need to put in longer work hours to make ends meet, the drive for volunteer work is not always easy to come by” says Dr Anil Kapur.

But for the World Diabetes Foundation it is important to stress that covering the cost of salaries should not be part of a project budget. For a project to be sustainable and its activities to continue when the donation terminates, the salaries should be covered locally e.g. by the health care authorities or the hospitals involved.

If manpower costs are covered by the WDF funds, it seems unlikely that they will be able to continue their work when the funds are terminated.

 “Apart from the monetary benefit another way of motivating the teams could have been improvement of the working condition, better equipped centres etc.” Dr. Kapur suggests.

WDF pleased by the results achieved

Overall the projects has lived up to our expectations Dr. Kapur explains: “We have to remember that this was a small project in a very poor and vulnerable country, implemented successfully at a time when there was great political turmoil and insecurity. In an environment of very low salaries, great impoverishment where people struggle everyday to make a living, poor education and no monetary benefits to the implementing team as well as the local teams, I am actually quite pleased with what was achieved”.

Read more about the project

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This page was last updated 5-6-2011 by bisl.wdf