Pictured: Kenya's Minister of Health, Ms Beth Mugo and Dr. Anil Kapur at the launch of Kenya's and Africa's first National Diabetes Strategy on 10 September 2010. (Photo courtesy of National Diabetes Comprehensive Care Programme)
The active presence of the Minister of Health, Ms Beth Mugo, during the official launch was in itself symbolic for the high-level involvement in placing diabetes on Kenya's national health agenda. In the foreword of the new strategy her intention is clear: "If the disease is not tackled, it will hinder the attainment of the Millennium Development Goals. In order to achieve effective diabetes control a coordinated and multi-sectoral approach must be adopted through out the country. It is our belief that collectively we can make a difference: Let us join hands in the fight against diabetes and strive to achieve a diabetes free Kenya."
The burden is big enough
There are an estimated 1.6 million people living with diabetes in Kenya today . However, it remains an estimate due to poor health records and data collection. Yet, according to Dr William Maina, Deputy Director of Medical Services & Head of the Division of Non-communicable Diseases in Kenya's Ministry of Public Health and Sanitation, "even without taking the other NCDs into consideration, the burden of diabetes is big enough to warrant special attention."
The overall goal of the National Diabetes Strategy is to 1) prevent or delay the development of diabetes in the Kenyan population and to 2) improve the quality of life and reduce complications and premature mortality in people with diabetes. In real terms, this means to roll out the strategy in three phases going from national to regional to district level. Core in the strategy is to train health care providers and community health workers to detect and treat diabetes so that, ultimately, they act as ‘diabetes ambassadors'. As it is today, often health care providers and patients do not have adequate knowledge about diabetes - if any at all.
A big win
"For the World Diabetes Foundation the launch of this new strategy is a big win," says Dr Anil Kapur who attended the official launch. "Several of our partners assured me that this would not have come about without the initial support from the World Diabetes Foundation to a project run by the Diabetes Management and Information Centre. That project and the subsequent collaboration with the MoH whetted their appetite and built their confidence they said. We are of course happy to see that our strategy of intervening at different level works. In brief, it is about empowering local champions to take the actions that are most relevant for their situation and environment in order to get things moving."
"Implementing comprehensive, integrated and holistic national programmes require substantial resources - human as well as financial - and the Foundation cannot fund such interventions singlehandedly," says Dr Anil Kapur. While we rejoice, it is important to keep in mind that sustainability and local ownership are crucial when World Diabetes Foundation decides to grant support. "In the five diabetes projects which the World Diabetes Foundation has supported in Kenya since 2005, co-funding has made up 72% of the total project budgets. For the National Diabetes Programme, co-funding makes up 82%. The World Diabetes Foundation's strength lies in the ability to lift the actual work from plan on paper to actual action on the field by providing an initial sum of money to show that it can be done and making governments believe in it."
The Ministry of Public Health and Sanitation will be the lead implementing partner and responsible for the overall implementation in collaboration with the Kenya Diabetes Management and Information Centre (DMIC). For technical assistance and to ensure cost-effectiveness and sustainability of the project, the Ministry will also collaborate with the World Health Organization, the Kenya Diabetes Association, the Kenya Diabetes Study Group and Kenya Diabetes Educators.
Mainstreaming previous efforts
Under the national programme, nine diabetes clinics have been established in provincial hospitals in all Kenyan provinces, and screening and awareness camps have been conducted. Besides from the recently launched National Strategy, manuals and guidelines for comprehensive diabetes care have been developed. The national programme is the fifth project in Kenya to receive support from World Diabetes Foundation and its comprehensive approach nicely wraps up and mainstreams all the previous efforts. In fact the strategy also envisions integrating treatment of diabetes with that of tuberculosis and HIV and AIDS management and creating links with maternal and child health programmes.
The fact that the National Diabetes Strategy has been prepared by and is anchored within the Division of Non-Communicable Diseases suggests the integrated approach towards the inclusion of other related diseases. Dr Maina reassures that the focus on diabetes is not a threat to an integrated NCD approach: "The diabetes strategy will provide us with a good entry point to prevention and control of most NCDs which share common risk factors. We aim to use this model to introduce an integrated chronic care model at health facilities to integrate diabetes, hypertension, cardiovascular and renal diseases under one roof in order to better utilise the scarce resources for maximum impact," he says.
World Diabetes Foundation has granted support to national programmes in two other African countries, namely Uganda and Ghana. Based on the project portfolio and the improved capacity, various other countries might soon have the capacity to launch national programmes. In spite of the current three national programmes in World Diabetes Foundation's portfolio, Kenya has now taken the lead in being the first country to publicly announce a strategy and initiate implementation.