The project seeks to strengthen the existing health care system and build capacity to deliver effective diabetes services in Prakasam district in the Indian state Andhra Pradesh.
Expected impact
A standard protocol for the care of people with diabetes and diabetic retinopathy developed
127,500 people with diabetes registered, screened for diabetes and retinopathy and followed up for treatment
600 village vision guardians trained
160 paramedical staff trained
100 general physicians trained
7 specialist teams formed in major towns in the district
30 ophthalmologists and 30 ophthalmic assistants trained
Information and education materials developed and disseminated
Results to date
Clinical forms have been completed for several diabetes specialities and are ready for test in the field. Patient enrolment form has been completed and translated into local language.
56,746 people with diabetes have been registered in the district, and a five-year baseline assessment has been initiated for 3,579 persons with diabetes.
6,210 persons with diabetes underwent eye screening. Of these, 68 have received laser treatment and 1,925 received surgery for the eye.
588 community workers have been trained during four training programs. They all work at village level and each one maintains details about 200 households on an average is and responsible for delivering health messages to their targeted families.
242 paramedics have been trained. They are mainly registered medical practitioners working in rural areas or from the government sector engaged in chronic disease management service delivery in the district.
134 general physicians from the public and private sector have been trained in comprehensive diabetic care covering all specialities such as diabetology, diabetic cardiology, nephrology, foot care, diabetic eye diseases and nutrition.
7 specialist teams have been formed.
19 ophthalmologists and 29 ophthalmic assistants have been trained.
1 secondary level eye centre and 5 primary level eye centres have been upgraded with glucometers. 3 secondary level eye facilities have been upgraded with green laser for treating diabetic retinopathy cases at the district level.
A manual on comprehensive diabetes care at the primary level has been developed in local language.
World Diabetes Day was commemorated and 6 awareness campaigns conducted.
Project details
In India, more than 40 million people have diabetes, yet many do not have access to appropriate treatment and as a result they experience severe complications such as diabetic retinopathy.
In Prakasam district in Andhra Pradesh, the existing public health facilities are not adequately equipped to offer even basic diagnosis and treatment for diabetes. Likewise, the eye care facilities in the area lack equipment for treatment of diabetic retinopathy.
The district is among the poorest in the state with 16% of the population living below the poverty line. Since poverty deters a person's access to the health care system, a large portion of the population is precluded from receiving proper health services.
Approach
The project is headed by L. V. Prasad Eye Institute and builds on the current capacities developed in the district under the ongoing WDF supported project "Health promotion and diabetes prevention" (WDF05-137).
Initially, a standard protocol for the care of people with diabetes and diabetic retinopathy will be developed. The protocol will subsequently be used to train various groups of professionals.
The plan is to screen for diabetes in all villages in the district and register the people who have diabetes. Comprehensive care, patient education and follow-up checks will be offered to those identified with diabetes. It is expected that 127,500 people will have diabetes in the district and thus benefit from this project.
In order to better reach people with diabetes in the villages, 600 so-called "village vision guardians" will be trained. The role of the village vision guardians is to assist in the screening and registering of all people with diabetes in the district, counsel them about lifestyle modifications, diabetes care and the importance of good control and periodic check-ups, and remind them when it is time for their follow-up examinations.
The capacities of the public health facilities and the non-for-profit organisations in the district will also be strengthened. 10 existing health centres will be up-graded with the necessary equipment and facilities for diagnosis and treatment related to special diabetes care. In addition, personnel from more than 50 health centres will be trained in standard diabetes care. Approximately 160 paramedics and 100 general physicians will be trained in order to improve the delivery of diabetes care.
In addition, seven specialist teams will be formed in the major towns in the district to ensure improved diabetes care. The specialities will be related to diabetes such as cardiology, nephrology, foot care and retina.
In the area of eye care, 30 ophthalmologists and 30 mid-level ophthalmic assistants will receive training on diagnosis and management of diabetic retinopathy. This improved capacity in the area of diabetic retinopathy will be used to carry out screening for diabetic retinopathy for all the registered people with diabetes and to provide eye examinations, laser services and surgery to the people who need it.
Meanwhile, information and education materials targeting people with diabetes, paramedical staff and medical professionals will be developed and disseminated to the relevant people throughout the project. The material will among other things inform the patients about how to take care of their health when they have been diagnosed with diabetes. Information about project activities e.g. screening for diabetes will be displayed on posters in public places.
