A peer education session given in Shikomori at a Health Center – Moroni, Comoros
In Africa, the number of people with diabetes is on the rise due to increasing urbanization and unhealthy changes to their nutrition and lifestyle. According to the International Diabetes Federation’s 2021 Diabetes Atlas, this number is predicted to increase by 129% by 2045, from 24 to 55 million people living with diabetes – taking a significant toll on the populations, the states and the already fragile health systems altogether.
This trend is amplified by barriers to care and primary prevention and a lack of support for a consistent multi-sectoral approach and policy changes. The scarcity of culturally relevant educational materials, as well as of diabetes specialists and dieticians have added to the challenge of improving the quality of life and health of the population
To address this, the local patient organisation FENADIM (Fédération Nationale des Diabétiques du Mali) together with ONG Walé partnered up with ONG Santé Diabète, a French non-governmental organisation (NGO) active across Africa and a long-term partner of our WDF, to co-implement a project strengthening diabetes care and prevention in Mali in 2020.
More on how NGOs are strengthening health systems in low- and middle-income countries, in this Global Health Action article on the impact of Santé Diabète in Mali.
Laying the foundation by empowering civil society
The intervention soon became a successful inter-country programme across Burkina Faso (WDF19-1734), Mali (WDF19-1736), and the Union of Comoros (WDF19-1735), in partnership with the Ministries of Health, to consolidate the national response to diabetes care and prevention by elevating on-the-ground access to quality care and education.
The projects have been co-funded by the French Development Agency and are led by civil society organisations to enhance local ownership and the sustainability of the results.
Patient Organisations Fédération Nationale des Diabétiques du Mali and ONG Walé and WDF's Programme Manager Ali N'Daye, at a Prevention House – Bamako, Mali
Strengthening the place and role of civil society within a multi-stakeholder network has proven essential. It has empowered all key actors – from people at risk or having diabetes, to national authorities, international organisations, healthcare professionals, the Ministry of Health - to drive institutional and operational strategies for a better quality of life in the long run.
The three projects in Burkina Faso, Mali and the Union of Comoros are advocating for patients’ rights and a meaningful dialogue on policy changes supporting the inclusion of diabetes care in the emerging universal healthcare coverage and increase of the number of professionals trained in diabetes and related complications.
Turning the tide on diabetes, one House at a time
One unique element of the programmes is the community-led Prevention Houses opened to increase peer education in terms of healthy lifestyles. In turn, the trained peer educators provide support and share knowledge to at-risk groups and people living with diabetes in their communities, encouraging diabetes prevention, screening, and self-management.
They supply physical spaces for awareness raising and capacity building and sharing, as well as being a sustainable solution to the lack of access to care and health education.
‘The Prevention Houses are managed by ONG Walé in Bamako and by patient associations in four other provinces, and they are a key achievement of the projects’, explains Ali N’Diaye, Associate Programme Manager at WDF after the first post-COVID visit from WDF in Mali.
‘Activities are carried out by peer educators – patients or patients’ relatives – and have a significant impact on the prevention of diabetes and its self-management - and, more broadly, non-communicable diseases (NCD) in children, adolescents and adults'.
Among the activities carried out inside and outside of the Prevention Houses are workshops on diabetes prevention, benefits of physical activity, weight management, and prevention of gestational diabetes, as well as free screening and referrals.
The houses were set up at the request of community representatives such as ONG Walé and the National Federation of Diabetic Patients of Mali (FENADIM) - key collaborators of the project in Mali.
Their success became an example for other countries.
‘The setup is very innovative and has been replicated in Burkina Faso and the Union of Comoros sharing a common goal: raising awareness about diabetes and its risk factors and providing therapeutic education and psychosocial assistance for free’, Ali adds.
These activities are carried out by Association Diabète Laisses Moi Vivre (ADLMV) in Burkina Faso, and Association Comorienne de Lutte Contre le Diabète (ACLD) in the Union of Comoros – as part of the Santé Diabète programmes in each country.
Activity held in a community centre – Bamako, Mali
During his visit, the WDF’s programme manager noticed the impact that such facilities have on the participants:
‘There is a real commitment to providing the peer educators extensive training. The workshops were easy to understand with accessible educational materials. The peer educators are very motivated to share knowledge on healthy lifestyles and diabetes self-management. It was interesting to see people being so keen on changing their lifestyles and attitudes and to hear their positive feedback’.
Awareness-raising activities are also carried out in schools and antenatal clinics to support healthier lifestyles among adolescents and pregnant women – in line with WDF’s new approach to primary prevention.
Change led by people with diabetes, for people with diabetes
This approach has helped individuals like Pauline Koubem, who struggled to accept her condition at first.
After being diagnosed with diabetes, Pauline took part in activities led at the Prevention House in Ouagadougou, Burkina Faso, where she met with peers and received educational resources from ONG Santé Diabète.
‘With the advice I received from the Prevention House and the treatment I received at the CHU Yalgado Ouedraogo [University Hospital], I was able to get my diabetes under control, and now I'm living better", shares Pauline.
Peer Educator raising awareness session on gestational diabetes, Djantodio Health Centre – Ouagadougou, Burkina Faso
The sessions are led by trained community health workers and peer educators, meaning that they are managed by people living with diabetes for people living with diabetes. As a result, resources are accessible in French and local languages, but pull their strength from the patient peer educators having a real platform to share their lived experiences.
What is more inspiring is that participants often become educators and contribute to their communities by passing on knowledge in culturally relevant ways. This guarantees the project’s sustainability and impact while empowering people with diabetes to live a better life.
An international capacity-sharing platform
Civil society might drive the projects within their countries, yet the projects act as an international knowledge-sharing platform, bringing about change beyond borders.
From the design of a multi-country project to an MoU signed between the French Development Agency and WDF, the projects fostered international collaborations at many levels.
In June 2023, key actors took part in a multi-stakeholder meeting held in Moroni. This supplied a platform to exchange experiences and implement structural changes to improve diabetes care and address comorbidities of diabetes, tuberculosis, and HIV. The partners had the chance to learn from and empower each other, sharing knowledge and building capacity.
This multi-sectoral approach has taken the interventions to another level, marking a significant milestone towards integrating diabetes and other non-communicable diseases care into health policies in Burkina Faso, Mali and the Union of Comoros.
While the three projects are in their final phase of implementation, they are already showing promising developments.
A new project supported by WDF is to be started this year and will build on the current success – seen with the opening of Prevention Houses, having better data on diabetes care and greater involvement of patient associations.