National Diabetes Programme, Tanzania

Objectives

The objective of this programme is to strengthen the capacity of the health care system to prevent, detect and manage diabetes and other NCDs, complications and related co-morbid conditions, and through this contribute to the strengthening of the national NCD response in Tanzania.

Approach

Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) is the leading implementing partner of WDF and is overall responsible for coordination, support and monitoring. The MoH collaborates with Tanzania Diabetes Association (TDA), the co-implementing agency of the national NCD response. Efforts are undertaken to integrate NCD responses into other health care sections within the MoH structures as e.g. HIV, Tuberculosis, Reproductive and Child Health. Linkages are also made with Association of Private Health Facilities in Tanzania (APHFTA) through which currently a school health programme strengthening is carried out in collaboration with various line ministries (see: grant ref. WDF13-719).

The national NCD response builds upon experiences and results from several previous WDF-funded projects: Recommendations developed after an independent evaluation of WDF05-102 and WDF07-265 by the TDA have guided the planning of the National NCD Response strategy in Tanzania, while the overall conceptualization at global level, first and foremost as expressed through the UN Political Declaration on NCDs (2011) and the WHO Global Action Plan on NCDs 2013-2020, defines the guiding principles for the various interventions.

The national NCD response programme targets district and regional hospitals across Tanzania where NCD services are established, and a gradual implementation towards primary care is outlined. The NCD clinics at all levels will be provided equipment to facilitate detection and management, including eye and foot complications, nutrition counselling, NCD and pregnancy services, and management of other co-morbid chronic diseases or communicable diseases related to diabetes (HIV/AIDS, Tuberculosis). Hence, integration of NCD services into other health programmes will be highly prioritized, see details here.

The national NCD response will promote the decentralisation of NCD care, and provincial and district level 'NCD coordinator' positions have now been established by MoH, as permanent positions of the service delivery and monitoring structures.Hence,raining of staff at various levels is a key element in the national NCD response programme. Overall focus of the training is to sensitise health care personnel on all aspects of NCD care and prevention and include specific training programs on eye diseases, diabetic foot, gestational diabetes, nutrition, other non-communicable diseases (like hypertension and stroke/CVD), metabolic complications in people with HIV/AIDS, as well as patient and community education.

Prevention, awareness and health promotion activities will be implemented across communities by community health workers, health management teams at district and referral level, community leaders, schools, media and other stakeholders. Community outreach activities will be based on lessons learned from Tanzania's HIV/AIDS strategy which has proven successful. The aim is to raise awareness on NCDs, its symptoms, risk factors and complications, and first and foremost to strengthen preventive measures since most NCD conditions are preventable.

It is another target of the national NCD response of Tanzania to establish multisectoral committees at the different administrative levels, to elevate the NCD challenge to a whole-of-society and whole-of-community matter, rather than a matter to be addressed only through the health system.

Supportive supervision and monitoring visits will be conducted throughout the period of the project, to carry out; surveillance, health status monitoring, health sector planning and policy making. Moreover, improved patient record systems and compilation will be a cornerstone goal of the programme, noting the scarcity of data on NCDs in Africa both from an individual patient perspective as well as in terms of cohort data.

Results at completion

• 2,438 health care professionals trained
• 354 community health workers and 245 nutritionists trained
• 223,540 patients treated through established clinics
• 148 clinics established or strengthened
• Mass media campaigns conducted