Type 1 diabetes in Africa – two decades of WDF impact

In Africa, children living with T1D face a particularly high risk of going mis- or undiagnosed and untreated. Even after diagnosis, the vast majority do not receive the necessary care. In sub-Saharan Africa, it is estimated that fewer than 1 in 4 people with a non-communicable disease (NCD) receive adequate treatment(2) due to: 

• shortages of trained health care professionals, 
• unavailability and affordability of medicines and supplies, 
• limited resources, 
• and gaps within the health system.

The consequences are immediate and profound: children experience emergencies, premature death, and lost opportunities for a normal childhood, while families carry an immense burden from both emotional distress and the cost of care.

Since its inception, the World Diabetes Foundation has sought to address gaps in T1D care. Within its remit of not providing medication, we focused on targeted initiatives to address identified capacity gaps:

• focusing on equipping paediatricians, nurses, and medical officers with the skills and resources to diagnose and manage T1D,

• equipping emergency rooms with capacity to test for and treat T1D,
• and supporting the establishment of T1D centres of excellence throughout Sub-Saharan Africa.

We set out to transform care for children and young people with T1D, create sustainable access to expertise, and enable lasting change for families and communities across the region. Over time, we found that early capacity-building would drive sustainable impact for years - well beyond the end of the funding.

Pioneering and setting new standards

When WDF first started funding T1D-focused projects, trained health care providers for paediatric diabetes were exceptionally rare throughout much of Africa. In 2008, WDF launched a regional paediatric care capacity building programme, collaborating with the University of Nairobi, Aga Khan University Hospital, and Gertrude’s Children Hospital. Their joint effort established the region’s first paediatric endocrinology training centre for Africa, also referred to as PETCA, guided by the European Society for Paediatric Endocrinology and International Society for Paediatric and Adolescent Diabetes.

Over the course of 18 months, 34 paediatricians from eight African countries - Botswana, Ethiopia, Ghana, Kenya, Nigeria, Sudan, Tanzania, and Uganda - would travel to Kenya to receive specialised, hands-on training on T1D. After their fellowship, each participant was expected to set up their own treatment facility, and train other health care professionals in paediatric diabetes care, multiplying the impact across their communities.

Due to the success of the PETCA programme, a second phase was launched in 2012 with WDF’s support, expanding efforts to additionally four African countries: Congo, Mauritius, Rwanda, and Zambia.

Building on the achievements, the second phase introduced local training courses led by former fellows, cascading expertise to hundreds of health care providers, and raising paediatric diabetes awareness at all levels. The programme went on to increase the number of paediatric diabetes clinics and trained several new paediatric endocrinologists, ensuring continuous mentorship and support.

According to PETCA Coordinator Dr Thomas Ngwiri, the programme's impact has extended well beyond its formal training activities. "We did a follow-up of the fellows, the graduates, and found that 70% of the fellows are working [with paediatric diabetes] in their home countries," he noted - highlighting the programme's emphasis on building locally rooted expertise.

This local retention has contributed to a remarkable ripple effect. When WDF funding ended in 2016, the programme had already established 23 new clinics providing T1D services and strengthened a further eight. By focusing on sustainable capacity-building and strong partnerships, PETCA has become a model for lasting change, improving futures for children and families affected by T1D across Africa.

Bringing care home

In 2012, Dr Amos Msekandiana joined the PETCA programme in Tanzania. As a paediatrician, he sought to improve health outcomes for children back home, in Malawi, where children with T1D were often misdiagnosed, untreated, or unable to access consistent care – a story Dr Amos knows all too well.

For Dr Amos, the fellowship became the turning point that allowed him to translate what he had seen in Tanzania into a new standard of care in Malawi. At first, the idea met resistance, as many believed there were not any cases to address. Yet, within just one month, several children enrolled for care, and more followed.

“Children were leaving the high-dependency unit in just 24 hours, healthier and stronger. The sceptics started to believe, and we kept going month after month.”

Dr Amos also established Malawi’s first diabetes nurse educator role and carved out a dedicated space within the hospital specifically for paediatric diabetes care. Despite it being just a simple set up at first, this clinic quickly became a lifeline for many families:

“We fought for our own space, and now we have a fully operational clinic that is transforming lives. From just five children, over four years we grew to more than 200 patients. The true change wasn’t just in numbers - the mindset shifted. Colleagues saw the difference and wanted to know what was being done.”

Today, Dr Amos continues to mentor nurses and clinicians through the WDF-funded national NCD programme, fostering a committed team focused on paediatric diabetes and other severe non-communicable diseases. With the support of the Ministry of Health, their collaborative training has extended nationwide:

“Now, central hospitals have nurses rotating through our clinic, learning about diabetes management. Through WDF and our partners, we have trained almost the whole country. This programme has truly changed the landscape for children and young people living with diabetes in Malawi,” Dr Amos notes.

Kenya: a hotspot for sustainable paediatric diabetes care

Though the PETCA programme reached many African countries, Kenya would continue to stand out, becoming a hotspot for paediatric diabetes care. While hosting the PETCA training programme, Kenya also saw the formation of the Paediatric Endocrine Society of Kenya (PESK), which has played an integral role in advancing efforts for children and adolescents with T1D. PESK - built largely by PETCA-trained specialists - led the development of national guidelines and education materials. Neighbouring countries regularly sent their future paediatric endocrinologists to Kenya for training, making the country a hub for expertise and inspiration across Africa.

“After nine years, the University of Nairobi took over certification, so now it’s a fully accredited fellowship programme - no longer just an internal initiative, but a recognised academic qualification.” - Dr Thomas Ngwiri

The ultimate testimony to the relevance of PETCA came in 2020 when it transitioned from a project funded initiative to a programme owned and run by the University of Nairobi. With that, PETCA's legacy endures through the enrolment of approximately two fellows each year coming from a diverse range of countries such as Kenya, Cameroon, Ethiopia, Tanzania, Sudan, Malawi, Angola and Nigeria. Anchoring training at the University of Nairobi, a regionally accredited institution, ensured fellows gained qualifications recognised across the continent. It also opened a pathway for graduates to be recruited as university lecturers and embedded expertise directly into academia.

This commitment to sustainability extended beyond training, taking root in national policy and finding a collective voice through the African Society for Paediatric and Adolescent Endocrinology (ASPAE), founded by PETCA fellows in 2010 to foster collaboration, share knowledge and advocate for paediatric endocrinology across the region. The scale of this growth is striking. Whereas just three paediatric endocrinologists were practising in 2008, ASPAE today counts nearly 100 members.

Kenya's journey showed how strategic investments and empowered local leadership can create lasting improvements for children and families affected by T1D, both at home and across the continent, with impact continuing well beyond the period of WDF funding. Through ASPAE and International Society for Paediatric and Adolescent Diabetes, WDF now supports expansion of the model into West Africa, with a focus on establishing a French-speaking paediatric care capacity-building programme.

Expanding regional efforts

PETCA helped significantly strengthen paediatric diabetes care and expertise in Africa, but many children with T1D still faced barriers to medicine and services.

To address this, WDF joined the Changing Diabetes in Children (CDiC) programme, a collaborative effort established by Novo Nordisk in 2009. The programme uses a strong partnership model involving national ministries of health, academic institutions, and global and local partners. It focuses on strengthening patient education, building capacity among health care professionals, and ensuring access to essential medicines for children and adolescents in LMICs. This led to the establishment of clinics, training of health care professionals, creation of guidelines and building diabetes registries in nine selected African and Asian countries. Of these, WDF co-funded projects in five countries, concentrating on training, camps for children, education, and clinical management alongside health systems strengthening. PETCA alumni and PESK members contributed to developing programme activities and sharing curriculum resources. These two programmes complemented each other, with PETCA providing advanced training for paediatric professionals involved in CDiC.

In 2017, WDF evaluated its engagements with the CDiC programme to ensure that its support was providing most value to the evolving programme. This brought a fresh momentum and a renewed commitment to sustainable diabetes care for children and adolescents. Building on its deep experiences across LMICs, we saw a meaningful potential in integrating T1D care into broader NCD national strategies, focusing on countries where NCD efforts were already well established and where we had strong partners working.

Through collaborative discussions with CDiC partners, a new approach was shaped in 2020: WDF would help strengthen the linkage between T1D management and national NCD frameworks. Eight countries, six in Africa (Ethiopia, Tanzania, Kenya, Malawi, Rwanda, and Mozambique), were selected for this renewed phase. This aligned with WDF’s strategic scope and areas where previous funding had laid solid groundwork. This project was co-developed with CDiC and co-funded by the Novo Nordisk Foundation, with the aim of both expanding access and embedding paediatric diabetes care into national health agendas for longer-lasting impact.

Across the six African countries, WDF’s renewed engagement has to date:

• strengthened 399 clinics,
• trained 3,660 health care professionals
• and ensured improved diabetes care for 18,496 children and adolescents.

Zooming in on just a few of the targeted countries, efforts in Ethiopia, Kenya and Malawi have already been fully integrated into the national NCD programmes; each telling a story of transformation driven by collaboration and local ownership.

Tanzania: Integrated and locally anchored

In 2005, Dr Edna Majaliwa began working at Muhimbili National Referral Hospital, awareness of T1D in children was extremely limited. Most families and health workers did not recognise the symptoms, access to insulin and blood glucose monitoring was unreliable, and clinical guidance for treating young patients was scarce.

“When we started, even health care providers doubted that children could get diabetes. The idea was so unfamiliar that many doctors and nurses simply didn’t look for it. It was a struggle to convince colleagues and families that diabetes could affect children” – Dr Edna Majaliwa, Paediatric Endocrinologist, Tanzania.

Launched in Tanzania in 2010, the CDiC programme introduced structure and consistency into diabetes care for children. In partnership with the Ministry of Health, the programme supported nationally adopted guidelines, reliable provision of essential medicines, roll-out of practical tools, and patient education in local language, allowing for care to be extended beyond hospital walls.

The programme focused on training people at every level of the health care system, so care could be provided not just by a few specialists in central hospitals but by a wide network of health workers across the country.

International collaboration and advanced training opportunities, such as the PETCA fellowship, equipped Dr Edna and her Tanzanian colleagues with specialised skills - opening doors to better diagnosis, treatment, and support for children living with diabetes. However, broad, sustainable change required coordinated action across the whole health system.

“The real change happened when we included everyone - nurses, clinical officers, and even parents. We no longer kept knowledge just within the hospital. Trainings became regular and inclusive, and we saw more children coming for care, more families feeling hopeful, and more staff wanting to learn.” - Dr Edna Majaliwa

The new system created stronger networks for parents, ensured children received timely treatment, and enabled health staff at all levels to respond effectively. As a result of the decentralised care, children began living healthier, fuller lives and families experienced a renewed sense of hope for the future.

Within a few years, diabetes care in Tanzania became more organised, locally anchored and much more accessible. Regional and zonal centres began to provide consistent diagnosis and treatment. The curriculum and guidelines Dr Edna helped shape with CDiC were adapted to local realities, giving practical advice that matched the routines and challenges faced by Tanzanian families. As Dr Edna’s story shows, local champions working in partnership with international initiatives and government support can transform a once invisible disease into an area of growing expertise, compassion, and hope for children living with T1D.

The next chapter

Looking ahead, the T1D landscape across the African region has improved a lot within the last decade, but the work is not finished.

More facilities offer structured care, national guidelines are increasingly operational, and supply chains have improved in several countries. Diagnostic capacity and awareness among frontline providers have advanced, and early signs of more reliable follow-up are emerging where patient registers and referral pathways are in place. Yet persistent gaps remain; late diagnosis is still common, continuity of care is fragile in rural and underserved areas with often long distances to clinics, and periodic stockouts alongside food insecurity can interrupt treatment. Stigma also remains a stubborn barrier, and as a result, families may hide a diagnosis, children can face discrimination at school, and psychosocial support is still scarce in many of the countries in the region.

To embed progress sustainably, building national programmes that are integrated and locally owned is essential. This means ministries of health in the lead, embedding T1D care within routine services, and aligning plans and budgets with country realities. It also means designing solutions around local needs to make education, care pathways, and supply systems fit the communities they serve. When programmes are built this way, they endure, scale, and continue to deliver for patients long after external funding recedes.

As the region moves forward, sharing knowledge across borders will be as important as securing supplies, echoing one of PETCA’s core principles. Clinicians and programme leads are already exchanging cases and practical solutions, learning from what works in constrained settings, and supporting one another through networks and mentorship. As Dr Edna Majaliwa puts it:

“We share our experiences and advise what works in our environment - and we learn from them too. We look out for each other and see how we can help with whatever we have.”

By strengthening these peer-to-peer platforms and networks, lessons, tools, and training can reach the next clinic, district, and country more quickly. This helps close gaps, maintains consistent care when staff rotate, and ensures good ideas are shared. The ultimate goal is to reach all children and adolescents living with T1D in Africa.

We remain committed to standing with partners across the region, from ministries of health to local communities, to strengthen locally led, nationally integrated T1D services. Building on the progress described above and the spirit of shared learning that has guided programmes like PETCA, we will keep supporting national ownership, exchanging practical knowledge, and investing where systems need it most.

References

1. International Diabetes Federation. IDF Diabetes Atlas, 11th edn. Brussels, Belgium: 2025. Available at: https://diabetesatlas.org
2. NCD Countdown 2030 Collaborators. “NCD Countdown 2030: Efficient Pathways and Strategic Investments to Accelerate Progress towards the Sustainable Development Goal Target 3.4 in Low-Income and Middle-Income Countries.” The Lancet, vol. 399, no. 10331, Mar. 2022, pp. 1266–1278, www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02347-3/fulltext, https://doi.org/10.1016/s0140-6736(21)02347-3.
3. Majaliwa, E.S. et al. (2022) ‘Survival of children and youth with type 1 diabetes mellitus in Tanzania’, Pediatric Diabetes, 23(8), pp. 1560–1566. doi:10.1111/pedi.13425.