Objectives & approach
According to the IDF Diabetes Atlas 4th edition, more than 1 million of the Sri Lankan population of 14 million people suffer from diabetes. Another 1.7 million have impaired glucose tolerance. This has led to a growing concern over diabetes and other non-communicable diseases in the country and the Ministry of Health has now recognised the need for targeting the rapidly increasing number of people at risk of or already suffering from diabetes.
The Ministry is therefore collaborating with the Diabetes Prevention Task Force on improving capacity and awareness about diabetes among the Sri Lankan population. These endeavours are now supported financially by WDF.
The project aims to improve quality and delivery of preventive and care services for diabetes in Sri Lanka.
The Diabetes Prevention Task Force, which is the main implementing partner on the project, was formed in 2005 under the guidance of the Sri Lanka Medical Association. The objective of the Diabetes Prevention Task Force is to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes in Sri Lanka.
This project consists of three components:
1. Training of nurses
2. Development of a health care model through a partnership between specialised tertiary care services and primary care services
3. Health promotion
The first component is directed towards developing a national programme for capacity building in diabetes care by training nurses as diabetes nurse educators. A total of 300 nurses from seven provinces will be trained. Initially, the nurses will come from the state health sector but with time it is the plan to expand the project to also include nurses from private primary care services. Nurses who assist in the management of diabetes patients in the state curative health sector will be prioritised.
The training programme will begin with a two-week course on the prevention of diabetes, psychosocial issues related to the disease, nutrition, pharmacological and non-pharmacological management of diabetes, gestational diabetes as well as diabetes-related complications such as diabetic foot. The course will be followed by three to six months work with diabetes care and completed with a one-week refresher and advanced course. The training will consist of both lectures and practical sessions.
When the training is completed the nurses will work at diabetes or medical clinics where they will assist doctors by providing in-depth health education on diet and lifestyle modification, encouraging self-care such as insulin self-injection, self monitoring, ensuring regular follow up and work towards improving patient care at primary and tertiary care.
The second component aims at developing a programme to provide quality diabetes care in the community through a partnership between the specialised tertiary care services and the primary care services in Colombo. In the primary care clinics under the Colombo Municipal Council there are no medical staff trained in diabetes care even though they currently cater to around 3,000 diabetes patients. The primary clinics also lack basic facilities necessary for provision of diabetes care. The intention is to empower the staff working at these primary clinics in terms of both knowledge/skills and resources with the help from experts working in tertiary care.
Primary care staff will receive training from the tertiary care staff, which will provide them with the ability to provide quality diabetes care. Moreover, the laboratory facilities at five of the Colombo Municipal Council clinics will be upgraded to provide better services in diagnosis of diabetes, in screening for diabetes-related complications and for assessment of their metabolic control.
The third and final component uses a health promotion approach to empower communities to develop healthy behaviours and thereby prevent the onset of diabetes. This component will be implemented at ten secondary schools, ten work places and in ten semi-urban communities.
The secondary schools are targeted as students especially in semi-urban areas are more prone to unhealthy eating habits, less physical activity, stress etc. The component seeks to reach about 2,500 students and 15,000 members of their families.
Ten work places with more than 50-100 workers employed and located in semi-urban areas will also be selected for intervention. The reasons for this are similar to those of the students: semi-urban workers are more prone to unhealthy lifestyles that increase the risk of diseases like diabetes. Both workers and managers will be targeted and at each work place one or two employees will be trained to enhance the effect of the health promotion.
The last target setting is in poor or middle income communities in semi-urban areas. Here too, unhealthy lifestyles are very prevalent. The problems are reinforced by an environment that does not promote physical activity as there are no recreational areas where such activities could take place. It is hoped that 3-5,000 people will be reached with health promotion in these communities.
To ensure the success of the third component, 15 health workers will be trained in health promotion during a two-day course whereupon they will carry out the implementation. As part of the health promotion plan advocacy activities, awareness raising via distribution of various materials and creation of screening facilities will also be conducted to facilitate healthy behaviours and prevention of diabetes.
- 300 nurses trained
- 5 clinics in Colombo strengthened
- 2,500 students, 500-1,000 workers and up to 5,000 members of semi-urban communities reached with health promotion
Results at project completion
- 188 doctors, 417 nurses, 12 medical laboratory technicians and 59 health promotion facilitators have been trained.
- 6 provincial clinics have been strengthened and 109,947 patients are being treated through these.
- More than 80,000 people have been reached through 526 awareness camps, including 133 health promotion settings the community has established with an average of 25 participants. 25,836 people have been screened during awareness & screening camps, of which 3,130 have been detected with diabetes.
- Various health education materials such as posters and bill boards have been developed.