1. To establish services for diabetes and hypertension care at health centre level in four target districts
2. To strengthen existing diabetes and hypertension services at hospital level to provide quality referral services
3. To assess how care for patients with diabetes and hypertension differs between hospitals and health centres
The project will pilot a model for integrated NCD-HIV care at eight primary health facilities in four districts in the Southern Region of Malawi.
Initially capacity will be strengthened at targeted health facilities through training of HCPs in diabetes and hypertension care using curriculum developed under WDF13-842 and with an emphasis on continued clinical mentoring of HCPs. Furthermore, equipment for basic diagnosis and treatment will be provided for health centres.
Regular systems for diabetes/NCD essential drug supply will be implemented at primary health facilities through mentoring of HCPs in drug forecasting, ordering, stocking and coordination of procurement with District Health Office.
Basic retinal photography will also be introduced at primary level, through smartphone technology. Captured pictures will be graded at Lions Eye Hospital (partner under WDF09-451 and WDF13-842), and patients with complications will be referred.
Diabetes self-management of patients will be strengthened through identification of peer diabetes patients who will conduct weekly diabetes education on clinic days as well as home visits to patients.
Referral between primary and secondary level will be improved through retraining of HCPs at secondary level and analysis of current mechanisms for referral, care and follow up at both levels.
Operational research and evaluation of project learnings will be presented to MoH NCD Unit with potential for replication.
DI has a strong local presence in the targeted districts and has collaborated closely with local health facilities on strengthening of HIV care based on a model of comprehensive training and mentoring. The proposed project will use the same approach with the mentoring role to gradually be taken over by secondary level hospitals.
- Diabetes/NCD clinics established at 8 primary health centre units
- 20 nurses and 33 HCPs trained in diabetes and hypertension care
- 1,000 patients treated at established clinics and trained in diabetes self-management
- 4 clinics at primary level strengthened to screen for DR
- 700 patients screened for diabetic retinopathy
Results at completion:
- 8 integrated diabetes/NCD clinics established in primary health facilities
- 3 existing NCD clinics strengthened in district hospitals
- 41 nurses and 74 HCPs trained and mentored in diabetes and hypertension care, including on aspects of drug ordering and stockage
- 1,397 patients treated at established clinics and 1,051 trained in diabetes self-management
- 1 clinic at primary level strengthened to screen for DR.
- 413 patients screened for DR.