Paraguay has experienced significant economic and human development in the last decades. Yet non-communicable diseases remain the main cause of morbidity and mortality in the South American country. With more than half the population obese or overweight, a high rate of tobacco use and excessive alcohol consumption (one third to half of adults), in Paraguay diabetes prevalence has reached 7.5% of adults and hypertension has reached 46% of adults.
This has left the country with a significant number of undiagnosed or inadequately managed cases of diabetes and other NCDs. Back in 2013, Paraguay’s Ministry of Public Health and Social Welfare approached WDF to discuss how WDF could help change this worrisome trend.
A powerful model
Paraguay’s public health care system serves more than 75% of the population, a larger share than in most other Latin American countries. Together, WDF and its partners in the Paraguay’s Ministry of Public Health and Social Welfare supported by the Pan-American Health Organization (PAHO), developed a plan for strengthening care and prevention of diabetes in Paraguay within the country’s public health primary health care framework.
The result was Chronic Care Model in 112 Family Health Units within the Framework of Primary Care, WDF13-795 – or as it became locally known, Modelo de Cuidados Crónicos.
The project was built on the ‘Chronic Care Model’, a widely-used framework for organising and providing care for people with chronic diseases promoted by PAHO. PAHO had piloted and adjusted the model to various countries in the region - in some cases via WDF-supported projects. In Paraguay, the plan was to combine primary health care capacity building within diabetes/NCDs with community level mobilisation and monitoring, adding prevention, education, and awareness to the core functions of the country’s primary care units (called ‘family health units’ in Paraguay).
The project was developed in three stages. First, a central coordination group under the responsibility of the National Diabetes Programme was formed. Next, the project adapted the Chronic Care Model to the local settings and implemented it in three selected health regions. The final phase focused on evaluation, follow-up and monitoring.
Pilar regional hospital, Ñeembucú, Paraguay, participated in the project.
Improved care for diabetes and hypertension
The improved services were gradually implemented across the three target provinces and at each of the 112 units - and more units were added throughout the project period, reaching a total of 127 by the project’s closure in 2020.
Improved care for diabetes and other NCDs (mainly hypertension) was provided to more than 127,000 patients during the project, and some 82,000 people at risk were screened. Glucometers, foot care kits and sphygmomanometers were distributed to all 127 units targeted, and HbA1c test kits for strategically located clinics were procured and distributed.
The project trained almost 900 health care professionals (physicians, nurses, assistant medical staff, other categories), nearly double the original target.
“I would rate this project as a resounding success both from the outcome as well as impact perspective,” says Dr Anil Kapur, Chair of the WDF Board. “There is no doubt that the project has improved care for diabetes and hypertension at the primary care level in Paraguay.”
Paraguay’s health authorities agree. “The project was considered such a success by the Ministry of Public Health and Social Welfare that it was decided to implement it nationwide over the coming years,” says Dr Gilda Benitez, NCD Unit Lead Official at the Ministry of Public Health and Social Welfare of Paraguay. She added that “the support of WDF to this project was very valuable in the improvement of diabetes and hypertension care in Paraguay, that produced very sustainable results for our health system.”
“For a philanthropy like WDF, the trajectory of this project followed an ideal scenario,” says Bent Lautrup Nielsen, Head of Global Development and Advocacy at WDF. “After a successful pilot project, the country has chosen to replicate the Chronic Care Model nationwide, improving the health and wellbeing of thousands more patients across the country.”