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 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.
WDF12-683 contains three main components:
Gestational Diabetes Mellitus - GDM (NCDs in pregnancy)
A group of diabetes experts will develop a training module with focus on the burden of Diabetes Mellitus Type 2 (DMT2) and GDM. Health care professionals will be trained in screening, diagnosis and management of GDM.
Obstetricians and physicians will be trained as Trainers of Trainers (ToTs). Groups of five from each of Sri Lanka’s 26 districts will be trained, resulting in 135 trained trainers. Their main tasks will involve empowerment of other health care personnel, like medical officers, midwives and nurses to screen, diagnose and manage pregnant women with GDM.
Materials on GDM will be developed and distributed to pregnant women with GDM and/or pregnancy induced hypertension. A “Centre of Excellence” will be established to perform follow-up of mothers and their offspring, and a database will be developed to follow up with the mothers and their offspring’s health.
Meetings with experts will be held to develop a training module for ToT in foot care. Trainers will subsequently train health care personnel at district level. A further 10 ToTs will be educated in adequate footwear at the “Centre of Excellence”, and the trainers afterwards will be trained an additional 75 students in foot care and footwear. A focal point for low-cost manufacturing of proper footwear will be established. Partnerships with the private sector will be initiated to ensure quality footwear and better outcome of diabetes related foot problems. A nationwide network will be established for the purpose of improving knowledge about the diabetic foot. The family members of people with diabetes and foot problems will be encouraged to help take care of the affected feet to prevent lower limb ulcerations and risks of amputation.
The existing health promotion model developed in WDF09-411 will be 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 will be selected as Health Promotion Facilitators (HPF) and trained in capacity building in health promotion. A number of students from five schools will be trained as 'health messengers'. Furthermore, 10 people from rural areas will be trained as HPF. These health promotion facilitators and messengers will raise knowledge and awareness levels in their respective settings. Politicians and other leaders will be approached with an advocacy package in order to inform them of the behavioural risk factors associated with diabetes and NCDs. They will be encouraged to support policy reforms to address the risk factors at the societal level.
Results at completion
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.