Rural and semi-urban diabetes prevention and control

Urban prevalence of diabetes in India is almost 12 percent - rural prevalence is "only" 3 percent. But with 75 percent of India's population residing in rural areas, a large number of people with diabetes require qualified care outside of the urban areas. Developing a national programme for prevention and control of diabetes for India is an enormous task. The first steps have been taken by the Government of India with the identification of an expert committee chaired by Prof. Ramachandran at the Diabetes Research Centre in Chennai. In recognition of the fact that the task at hand is enormous, the Government of India is looking towards the private sector and non-governmental organisations to partner with them to evolve and implement an effective and feasible programme. This project is one step in that direction.  Objective The project aims to initiate a diabetes prevention and control programme in rural and semi-urban parts of India where access to good quality health care is limited. Approach Three partners have come together to address the problem of diabetes care delivery in rural and semi-urban communities through a collaborative effort. The partners are: Christian Medical College (CMC), Christian Medical Association of India (CMAI) and Schieffelin Leprosy Research and Training Centre (SLR&TC); all situated in Vellore, India. CMAI have over 350 affiliated mission hospitals distributed throughout India, but mainly in the North, where government and private sector services are unavailable. These hospitals provide care at a reasonable cost, affordable to the poor. CMC is one of the oldest and most recognised medical colleges in India. It has 1800 beds and functions as referral hospital for the CMAI hospitals. SLR&TC brings internationally recognised expertise in the area of foot ulcers, one of the most debilitating complications of diabetes. The project focuses on four key areas: Community education, capacity building among doctors at CMAI hospitals, training of nurse diabetes educators and provision of improved foot care, including training of podiatrists and production of appropriate footwear. In the area of community education the project seeks to educate the community as a whole but targets special groups in the awareness programmes, including high schools, industrial workers, self-help groups and the leaders of the panchayats. Educational methods include pamphlets, posters, small group discussions and cultural groups of youth performing street plays to spread the message. 20 CMAI hospitals will participate in the community education activities. Capacity building will take the form of training of doctors, nurses and podiatrists to improve the quality of care offered at the CMAI hospitals. Doctors will be trained for 3 days at CMC. The training programme for nurses will be of 2 weeks' duration. The aim is to encourage self-care and reduce hospital visits and admissions. The podiatric training will be of one-year duration. An in-take of 15 students per year is expected. Apart from training podiatrists the project also focuses on the provision of suitable and affordable footwear to people with diabetes. Experience shows that ulcers recur due to use of inappropriate footwear or lack of footwear. Orthopaedists will be trained in the production of footwear using micro-cellular rubber, used for the prevention of ulcers. Expected impact An estimated 100 hospitals affiliated with the Christian Medical Association of India will participate in and benefit from the capacity building of the project. 200 doctors from these hospitals will be trained.  75 podiatrists will be trained to improve foot care 200 nurse diabetes educators will receive training to improve the quality of diabetes education Results to date A 'Diabetes Manual' for doctors, a 'Diabetes Health Manual Booklet' and a CD containing all the training material have been produced Several health education programmes have been conducted in the community reaching 538 teachers or head masters, 1500 school children, 46 panchayat leaders, 255 industrial and factory workers and 29 community health promoters 60 doctors and 75 diabetes nurse educators have been trained in the management of diabetes and creating awareness and prevention of diabetes in their localities Training has been conducted at 59 hospitals and around 42 of them have functioning diabetes programmes 31 orthopaedic shoe makers and 38 foot care technicians have been trained 233 village clinics have been held since January 2006 visited by more than 2500 patients Awareness programmes include a troupe trained in diabetes performing 19 street plays reaching 6400 people Approx. 760 diabetes patients have been screened at the ophthalmology department, about 70 of them had retinopathy More than 65 cataract camps were held and 1239 patients were screened for diabetes of which 226 had raised blood sugar levels A footwear unit that has been established enabling patients to use protective footwear; 659 pairs of foot wear have been issued In November 2004, 2005 as well as in 2006, several events have been arranged in commemoration of the World Diabetes Day/Week to raise awareness about diabetes; among the activities were quizzes for medical students, poster competitions, an essay and painting- and a song and dance competition, a walk-a-thon and an awareness and screening camp

Project data

Area Partners Project responsible Duration Project budget WDF contribution Project number

North-East India  Christian Medical College Christian Medical Association of India Schieffelin Leprosy Research and Training Centre Dr. A. Joseph June 2004 - May 2008 EUR 619,240 EUR 351,560 WDF03-057

This page was last updated 11-6-2007 by taj.wdf