Objectives and approach
Diabetes and NCDs is huge challenge in Sri Lanka with an estimated more than 1 million people suffering from diabetes alone.
The Sri Lanka Ministry of Health (MoH Sri Lanka) has recognized the need for targeting chronic diseases (NCDs). To change health behavior among people at risk, knowledge and awareness of diabetes and other NCD, their risk factors and prevention is a main priority.
The WDF support to the Sri Lanka national NCD response programme consists (primarily) of two phases, phase 1 (WDF grant ref WDF12-683, completed) and phase 2 (grant ref. WDF15-1291, details listed below, separate website description in preparation).
The objective of the WDF support to the Sri Lankan national NCD response is to improve quality of diabetes and related NCD care, particularly in relation to maternal health and with focus on NCDs in pregnancy, as well as diabetic foot care. In addition the WDF support also aims to address prevention through health promotion at the workplaces, schools and in community settings.
The approach builds on the success of 'Nirogi Lanka' project (WDF09-411) which focused on building capacity for diabetes education and care delivery, for improving quality of care by developing a partnership model between specialized tertiary care services and primary care services by improving infrastructure of five primary level clinics and health promotion for people with diabetes in Sri Lanka particularly in the metropolitan Colombo area. The same project partner, Diabetes Prevention Task Force of the Sri Lanka Medical Association, has taken lead together with Sri Lanka College of Endocrinology, as implementing agencies in close collaboration with MoH, and supported by WHO Country Office.
Phase 1 (grant ref WDF12-683) consisted of three main components:
Gestational Diabetes Mellitus - GDM (NCDs in pregnancy)
A group of experts in the diabetes field developed a training module with focus on the burden of Diabetes Mellitus Type 2 (DMT2) and GDM. Health care professionals were trained in screening, diagnosis and management of GDM.
Obstetricians and physicians were trained as Trainer’s of Trainers (ToT). Groups of five from each of Sri Lanka’s 26 districts were trained, resulting in 135 trained trainers. Their main tasks involved empowerment of other health care personnel, like medical officers, midwives and nurses to screen, diagnose and manage pregnant women with GDM.
Materials on GDM were developed and distributed to pregnant women with GDM and/or pregnancy induced hypertension. A “Centre of Excellence” was established to perform follow-up of mothers and their offspring, and a database was developed to follow up with the mothers and their offspring’s health.
Meetings with experts were held in order to develop a training module for ToT in foot care. Trainers subsequently trained health care personnel at district level. A further 10 ToTs were educated in adequate footwear at the “Centre of Excellence”, and the trainers afterwards trained an additional 75 students in foot care and footwear. A focal point for low cost manufacturing of proper footwear was established. Partnerships with the private sector were initiated to ensure quality footwear and better outcome of diabetes related foot problems. A nationwide network is being established for the purpose of improving knowledge about the diabetic foot. The family members of people with diabetes and foot problems were encouraged to help taking care of the affected feet in order to prevent lower limb ulcerations and risks of amputation.
The existing health promotion model developed in WDF09-411 was evaluated; further adjusted and strengthened before implementing in different settings to improve healthy behaviour. 1,000 employees from five work settings in an urban area were selected as Health Promotion Facilitators (HPF) and were trained in capacity building in health promotion. A number of students from five schools were trained as 'health messengers'. Furthermore, 10 people from rural areas were trained as HPF. These health promotion facilitators and messengers would raise knowledge and awareness levels in their respective settings. Politicians and other leaders were approached with an advocacy package in order to inform them of the behavioural risk factors associated with diabetes and NCDs. They were encouraged to support policy reforms to address the risk factors at the societal level.
Results at completion of phase 1
1 centre of excellence established for gestational diabetes care.
15 care units established
> 1,000 health care personnel trained in foot care. 12 foot technicians trained as training of trainers at Jain Institute Bangalore
> 3,000 patients screened for foot complications and more than 11,000 diabetic shoes produced and sold
> 8,000 health care personnel trained in GDM screening and care, including training of trainers
> 14,000 women screened for GDM with a reported prevalence of 22-24%
> 5,000 people sensitised and participated in primary prevention activities through establishment of 43 community settings, 10 workplace settings and six school settings. 195 health promotion facilitators, 25 aerobic trainers trained
2,135 school children trained as health promoters in schools and 413 teachers trained. 1,052 community health facilitators trained in healthy living and 4,872 employees from works settings trained in health promotion
IEC materials on GDM, foot care and health promotion produced and gestational diabetes and foot care training material and guidelines developed.
Phase 2: WDF grant ref WDF15-1291
WDF grant: USD 720,000
Grant period: 2016-2019
The second phase of WDF support to the Sri Lanka national NCD response elevates, refines and expands the outcomes of phase 1. All materials and guidelines produced are revised in order to become comprehensive NCD guidelines on care and prevention, and large scale training programmes of more than 3,000 health care professionals are outlined, including medical officers, nurses, midwives and various other categories including with health promotion, community health workers etc. More than 250 health care service units across Sri Lanka will be targeted and all surrounding communities and wider populations groups will be reached with education, awareness, prevention and screening activities. Data collection and monitoring will be further institutionalised at all levels. Emphasis of the second phase will remain on NCDs and pregnancy, on diabetic foot care, and a wider 'NCD prevention' approach will be rolled out nationwide.
Expected results phase 2
250 health care units to have established NCD care and prevention services
More than 3,000 health care professionals to be trained within a wide range of NCD related areas, incl with emphasis on the integration of NCDs with maternal care/RCH, and, with large-scale awareness, prevention and screening programmes to be rolled out with a total number of people to be reached of more than 200,000 and with more than 7,500 pregnant women included.