Objectives

1. Increase population awareness about diabetes and other NCDs.
2. Improve availability of skilled services for the prevention and control of diabetes and other NCDs, including maternal and child health services.
3. Strengthen data systems and reporting on NCDs.
4. Strengthen pooled procurement to improve access to affordable essential medicines and equipment for people with NCDs.
5. Strengthen national coordination and financing for prevention and control of NCDs.

Approach

The project represents a comprehensive framework building on outcomes, structures and material successfully established under WDF15-1232. This second phase will introduce a partnership with Defeat NCDs to include focus on supply chain and financing for NCD services in Rwanda.

The project will roll out a comprehensive model for prevention, awareness raising and screening at the community level where Community Health Workers (CHWs) are empowered, trained in community engagement on NCDs and linked to health centres. Trained CHWs will conduct education on NCD risk factors and risk-based screenings in communities where at-risk patients, including pregnant women screened for Gestational Diabetes Mellitus (GDM), will be referred to health centres for comprehensive diabetes screenings.

Provision of diabetes care at primary and secondary level will be strengthened. This will be based on revision and update of policy, testing and treatment guidelines for management of diabetes and other NCDs, and re-training of nurses at District Hospitals (DHs) and Primary Health Centres (PHCs).

Maternal and Child Health will be integrated into NCD prevention at the primary care level through systematic GDM screening among pregnant women during antenatal check-ups, effective management of GDM during pregnancy, and post-partum screening of women with GDM to prevent conversion to Type 2 DM.

The pathway for referral and patient registration will be improved through the roll out of a component for electronic medical record registries at PHCs. Improvement of care at primary and secondary level will be supported by the strengthening of multisectoral responses at the national level including the establishment of a digital training platform.

A pooled funding mechanism for NCD response will be established to catalyse joint financing alliances and mobilise domestic resources. The project will pilot Defeat NCDs’ global market-place mechanism to establish a fair, competitive environment for price-tracking and supply chain management.

Expected results

• 42 district hospitals and 483 PHCs strengthened.
• Availability of drugs improved and stock-out rates reduced. 
• 550 nurses from primary and secondary HCs trained.
• 3,000 PHC staff and 15,000 CHWs provided with online interactive trainings in diabetes screening and prevention.
• 42 Ophthalmic officers trained in early DR screening.
• 800,000 people screened for diabetes NCD risk factors.
• 24,000 people (3%) expected to be diagnosed with diabetes.
• 150,000 NCD patients (of which 16,000 with diabetes) reached annually with essential package of diabetes / NCD services at primary level. 
• 50% of pregnant women screened for GDM