An insight into World Diabetes Foundation’s support to clinics By Communication Coordinator, Brit Larsen Someone once asked me the question whether it wasn’t absurd to go into the bush where there is limited health care and build diabetes clinics. The answer is simple: “Yes, that would be totally absurd.” The notion of erecting separate diabetes clinics is not only absurd, it is also erroneous. In this article, two managers explain the Foundation’s actual support to diabetes clinics, why salaries, bricks or buildings are not part of the support granted by the Foundation and how support to treatment poses a challenge to the mandate of the Foundation. Need-based support Programme Manager at the World Diabetes Foundation, Ms. Sanne Frost Helt explains how clinics represent a key part in the Foundation’s support to alleviating the burden of diabetes in developing countries: “A basic diabetes clinic rests on a few simple pillars: a space, trained personnel, a diabetes equipment kit, a treatment protocol and education material for patients. But most of all, a diabetes clinic builds upon existing structures because in its nature, diabetes care is connected in so many ways to other fields of health care. We are extremely cautious about not draining the existing health care system when bringing in resources for a new health component. Rather, we aim at strengthening it through capacity building in order to make treatment better and more efficient. We support clinics based on a need expressed by a local partner who will often become the implementing part. By doing so, we aim at ensuring that the clinics feed naturally into the existing health setting and in my view, this is the best way of ensuring long term sustainability. Continuity should by no means depend on the support from the Foundation, and we do not want a situation where the incentive to work in a diabetes clinic disappears with the completion of a project. Consequently, the support from the Foundation never covers staff salaries. Nor do we support bricks and buildings; only the interior in terms of trained human resources and the most essential equipment. Typically, a diabetes clinic is an adjacent room at the hospital which will be used for diabetes patients on a set weekday and be used for other purposes the other days. Because clinical officers or nurses are rarely trained in diabetes, training is an integral part of setting up a clinic. Therefore, setting up clinics is not about creating advanced state of the art facilities. It is about diagnosing and identifying the condition in order to be able to treat it. Not surprisingly, the perhaps most important impact of educating health care personnel and patients is early diagnosis. All too often, patients in low-resource health systems are not diagnosed with diabetes until they experience severe complications. We can change this and the World Diabetes Foundation’s support to the training of 67,000 health care personnel throughout our projects exemplifies that this can be done with a relatively small investment. Any leg saved from amputation or eye saved from blindness is a success - not only for the individual but certainly also for the society as a whole. Dealing with diabetes and preventing costly complications improve life for people with diabetes in poor settings. For them a diabetes diagnosis no longer needs to be disabling nor a death sentence.” Sustainable funding principles Once basic care has been provided, the work with identifying and diagnosing the patients can begin. But of course, diagnosing a patient without having the means to treat them is dissatisfactory – to the health care provider as well as to the patient. In this interview Managing Director of the World Diabetes Foundation, Dr. Anil Kapur goes into the challenges and limitations in funding diabetes care and treatment. More than 1,800 clinics to date. Were all these clinic built out of a conscious vision? “Yes. We need to get care to people with diabetes as close to where they live as possible. Services must be the closest to the patient. Oftentimes, the cost of travel is higher than the cost of treatment. Typically, the development has been top-down: from provincial hospital to district hospital to community level and in some cases to micro clinics & peer-to-peer programmes. With the recent developments within mobile clinics, the most advanced care comes to the doorstep of people and the distance of travel is minimised the most. Once basic care has been established, the climb towards more specialised treatment can commence.  For the World Diabetes Foundation this poses a challenge as we do not want to engage in treatment as such; we rely on local partners to cater for patients. Having said that, we know that a local supply chain system must be in place first and this is problematic in many places.” What is World Diabetes Foundation’s position on providing treatment and medicine? “The World Diabetes Foundation is a small organisation and we cannot fund treatment on a continuous basis. While treatment is an important element of providing access to care and of secondary prevention, we do not believe that it is our role as a Foundation to provide free medicine, nor is it sustainable. The responsibility of procuring and distributing medicine has to be with the local authorities for it to be sustainable in the long-term.  The reason why people are all too often diagnosed and treated late has very little to do with drug availability. In the poorest countries of the world where the density of health personnel is low, it is the primary lack of understanding and knowledge about diabetes which causes poor care. The World Diabetes Foundation therefore focus on efforts to address the primary need for training health care personnel. In our view, this is sustainable capacity building.    No foundation can solve a health problem on its own, and it is important to remember that the World Diabetes Foundation is merely a catalyst that empowers and supports the local implementing partners. In general, we do not support free medicine including insulin in our projects. This has only happened in exceptional situations such as in war torn settings or in projects supporting children. The recent Changing Diabetes in Children Programme is an example of a formal partnership with the industry where the World Diabetes Foundation supports capacity building while the industry provides insulin and other diabetes supplies for free to type 1 children for a specified period with the hope that governments will wake up to the fact that providing insulin and other supplies to these children is not merely a matter of making a treatment available but is tantamount to their basic human right to live.” What about the quality of the 1,812 clinics? “Most of them provide basic minimal care and service, while some like the advanced mobile clinics provide the state of the art care literally at the doorstep. One could of course ask if the staff is able to do anything at the basic clinics if they are not adequately equipped or if the trained staff have transferred to do other things as is sometimes the case. The other issue is that patients may be treated but the record keeping is poor which means that it is difficult to get information out of the clinic. Rome was not built in a day and this is a process of learning by doing; over time they will understand how to do it right. We also facilitate learning and sharing of best practices through our peer exchange program and diabetes summits. In my opinion, even if half of the clinics we have supported remain functional, it is still a great development.”       The World Diabetes Foundation clinic model The capacity strengthening is founded on a wish from the Ministry of Health and by a health care facility. This principle expresses World Diabetes Foundation's emphasis on local ownership in order to ensure sustainability. The Ministry of Health commits to allocate the health care personnel including running costs such as salaries and consumables. World Diabetes Foundation's support typically includes: Staff training in diabetes (continuous process) Strengthening infrastructure through equipment and distribution systems Staff and patient education guidelines on self-management, diet and physical activity   Visit the Virtual Clinic to get inspiration to the elements in a diabetes clinic

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