Approach

The proposed project represents a second phase ASD/DGHS collaboration to scale-up a DM care model successfully introduced in 84 rural health clinics (RHCs), covering 10 districts through WDF19-1694.

The project will expand the DM care model to a further 87 RHCs, covering an additional 10 districts, while also developing and integrating a footcare component in all 171 RHCs and establish referral capacity for foot complications.

Main activities are:

1. Revision and development of step-by-step footcare model applicable in the public facility setting and integrate it into the existing DM model, incl. development of training materials and treatment protocols. Doctors, specialists, and other HCPs to be trained on DM and footcare according to contextualised guidelines. Cobblers to be mapped and trained in suitable footwear for diabetic foot conditions, based on experiences from WDF15-1272 and supervision from BIDE.
2. Scale-up and roll out of the integrated basic diabetes care model at RHCs, incl. footcare. RHCs to be strengthened through IEC materials, trained staff, electronic medical records (EMR) incl. digital referral system. RHCs to deliver screening and care of DM and related foot complications. Referrals to district level hospitals for advanced care and to existing BIDE centres for advanced footwear support to be supported.
3. Facilitation of community engagement and peer support through digital solution; existing application to be updated with footcare component. Community outreach through CHW; enrolled persons to engage in knowledge seeking, challenge reporting and peer support activities.
4. Substantial monitoring and evaluation of project model to inform advocacy initiatives at provincial and district level incl. health authorities, WHO, CSOs and affected communities.

Expected results

• 20 districts (total pop. 58 million) with improved access to basic diabetes and DM related foot care and prevention
• 171 RHCs and 20 district hospitals strengthened
• At least 500 doctors, 40 footcare specialists and 350 other HCP cadres trained in diabetes and diabetes footcare
• 200 cobblers capacitated within production of suitable footwear
• 40,000 people diagnosed with diabetes and treated
• 50,000 people with diabetes (new and known) received foot screening, care and referrals
• Digital application developed to support community engagement through peer-support, responsive care, and tele-consultation functionality
• 2 project related articles published in peer reviewed journals