Objectives & approach

Diabetes and the metabolic syndrome represent two rapidly increasing health problems in Botswana. However, both the public and the private health structures require support to handle the rising burden of chronic diseases and their complications.

Realising the emerging double burden of diseases and with HIV programmes having stabilised the epidemic, the Ministry of Health (MoH) has recently established a department of NCD control.

The MoH and the Ministry of Local Government (MLG) have clearly expressed the need for health education and health promotion to deal with the emerging diabetes burden and to address the need for diabetes care and management. There is an expressed need for skill and competence development amongst health care professionals to ensure comprehensive and effective management of diabetes and its complications.

Objective
The aim of this project is to improve prevention and management of diabetes and its complications by developing a community health educational network for people with diabetes and by establishing foot care clinics.

Approach
In collaboration with the MoH, the MLG, the Heart Foundation of Botswana and the local diabetes association, this project wishes to establish an organised network of health professionals and community workers to support people with diabetes and people at risk of diabetes and cardiovascular diseases.

The project will be implemented in 2 referral hospitals, 6 district hospitals, 1 heart clinic and 1 local association. The aim is to create a holistic approach to diabetes management and prevention, comprising doctors, nurses, pharmacists, nutritionists, podiatrists and other health care professionals, enabling them to identify high risk individuals and prevent devastating long term complications.

This would be achieved through the following actions:
• Training of 60 health care providers in advanced diabetes care within the MoH structure. APSA will collaborate with local diabetes consultants as well as the Centre for Diabetes and Endocrinology in Johannesburg, South Africa, to develop an advanced comprehensive three day training course.
• Set up educational and care network, and include training of 90 health care professionals (30 community doctors, 30 nurses and 30 health educators) from the public and private sector in leading education sessions and self care training for people with diabetes. The goal is for them to conduct diabetes education for 3,000 people living with - or at risk of diabetes.
• Set up a diabetes registry to ensure better monitoring enabling the health care professionals to manage the chronic disease in a proactive and organised fashion. It will make early detection of complications possible, thereby improving the lives of people with diabetes.

In addition to the above, ten foot care clinics will be set up in which 10 teams of doctors and nurses will undergo training in the Step-by-Step foot care model. This is done to reduce the prevalence of lower limb complications and to empower people with diabetes to better care for their feet. It is expected that the amputation rate can be lowered by 50% because of improved care and early detection of complications.

Expected results 
• 60 health care professionals trained in advanced diabetes management within the MoH structure
• 90 Health care professionals (30 community doctors, 30 nurses and 30 health educators) trained in leading educational sessions
• 3,000 people with diabetes trained in diabetes management
• 10 foot clinics established
• 10 teams of doctors and nurses trained in Step-by-Step foot care
• More than 2,000 people with diabetes will benefit directly from improved foot care
• A diabetes registry for people with diabetes established
• More than 2,000 people with diabetes will receive improved care and follow up from trained health care providers

Results to date
• 8 clinics have been strengthened and equipped with foot care kits
• 123 nurses and 41 doctors trained in foot care out of which 18 nurses and 7 doctors have participated in advanced Step-by-Step foot care training
• 60 doctors, 188 nurses and 39 paramedical staff have been trained in diabetes management
• Approximately 4,000 patients have received treatment through the 8 clinics
• 8,433 foot consultations have been conducted reaching approximately 4,000 diabetes patients
• 3,140 patients have been trained on reducing cardio vascular risk