China continues to create access to care

More than 40 million people presently live with diabetes in China.

They used to eat lots of vegetables, rice, soybeans, and only occasionally slices of meat. For centuries, the traditional Chinese diet was equal to a healthy diet, but not anymore. The spill over effect of the fast paced economic transition and development has produced a generation with higher living standards and allowed Chinese families to put more food on the table.

With one in every five person in China being either overweight or obese, China faces serious health challenges. Presently, more than 40 million people live with diabetes in China and by 2025 this number is expected to rise to 60 million if preventive measures are not taken seriously. Presently, the health delivery system is inadequate and the local population has little knowledge of how to manage diabetes. A major health promotion programme administered by the Chinese Ministry of Health seeks to change these alarming trends with support from the World Diabetes Foundation.

Ready to board phase 2

The National Diabetes Programme has been running since 2003 with the clear objective of improving the capacity to prevent, detect and treat diabetes. The goal has been to reduce the burden of diabetes on the Chinese society, and the way to approach this enormous challenge has been three-fold. First, a national diabetes prevention and treatment guideline should be developed. Secondly, a diabetes management system should be established at hospitals. And thirdly, the diabetes management systems should be transferred to community level.

Today, The National Diabetes Prevention and Treatment Guideline is already in place and widely used for training health care personnel. Almost 12,000 health professionals have been trained and more than 68,000 screenings conducted. However, the development of a two-way referral system encountered some difficulties. Dr. Anil Kapur, Managing Director of the World Diabetes Foundation explains why; “The model was supposed to have been launched in six pilot cities and then extended to 50 cities, but due to systematic problems this only happened in nine cities. One reason was the quality of care at the community health centres. When patients went to the large hospital they realized that the quality of care was much better than at community level and therefore they did not want to return. Another reason was differing reimbursement levels which meant that larger hospitals did not want to send the patients back to the community health centres because they would lose their income.”

“Based on the deficiencies learned during the first part of the project, the Chinese Ministry of Health has understood the importance of an on-going focus, which must be on community health centres,” says Dr. Anil Kapur. “If the level of diabetes care relies only on the large hospitals, the pressure will increase. Therefore, consolidating the key lessons learned, there is a clear motivation for diabetes care to be delivered as primary care at community level,” he explains. The second phase of the programme will set sail early 2009.

Living standards are on the rise in China. So is the prevalence of diabetes.

Linking primary care with prevention

During a recent visit to the World Diabetes Foundation in Copenhagen, a senior delegation lead by Dr. Lingzhi Kong, Deputy Director General of the Bureau of Disease Control from the Chinese Ministry of Health presented to the World Diabetes Foundation management and board members some of the positive results they have obtained working with diabetes prevention in the province of DaQing. A study was conducted among a group of people at risk of developing diabetes. Normally, 90% of this group would initially develop diabetes, but of those trained in preventing diabetes, only 73% developed diabetes. And they did so three to six years later than normally. “This is a clear example that prevention works,” says Dr. Kong. “Making persons at risk of developing diabetes understand the consequences of diabetes, is the best motivation for them to try to avoid it. If we can postpone or even avoid that people develop diabetes, we gradually accomplish our goal of reducing the burden both for individual as well as for the entire health care system.”

However, when dealing with prevention of chronic diseases like diabetes, Dr. Kong is well aware of the continuous challenges in changing the tendency: “We do not only deal with severe changes in lifestyle in comparison to the traditional Chinese lifestyle; we also deal with an incomplete health security system that lacks both service and capacity. And we deal with a low level of awareness of managing diabetes both among health care personnel and patients.” In order to meet these challenges, the key elements in the current project are to advocate for and promote a healthy lifestyle, diet and exercise,” explains Dr. Kong. All together the activities in the second phase of the project will be targeted towards 1,025 community hospitals, 8,200 health care professionals and 205,000 patients with diabetes.

“If successful, with this second phase of the project we are now moving diabetes to a primary care level which will be more sustainable. Furthermore, we may be able to link primary care with prevention and this is not possible to accomplish at hospital level,” says Dr. Anil Kapur. “If we succeed in reaching more than 1,000 communities in China it will be a huge development which will improve access to care greatly.”

This current project is a continuous supplement to the China National Diabetes Management Project initiated in 2003. It is funded by the World Diabetes Foundation in collaboration with Novo Nordisk China Pharmaceuticals and the Ministry of Health. The World Diabetes Foundation currently supports four projects in China of which the National Diabetes Programme is by far the biggest and the only nation-wide programme.

Read more about the project