For people living in poverty in Cambodia, diabetes will often mean that the family sinks deeper into poverty.For people residing in rural areas, proper care is often not accessible due to long distances and lack of health insurance, thus they are not able to pay for health care services. Without proper care, diabetes will affect a person's productivity.Consequently the children have to drop out of school and land is sold off. Hence, there is a considerable need for diabetes prevention and self-management education, not only to prevent diabetes but also to prevent poverty.To establish a peer education programme focusing on people living with diabetes who are vulnerable to poverty.
The project builds upon the existing MoPoTsyo urban slum experience, which has delivered good results in the last year an a half. The Provincial Health Department in Takeo has formally invited MoPoTsyo to expand its activities to involve the Ang Roka operational district.The initiative aims at enabling people with diabetes to self-manage the disease by engaging a peer educator in their own community. The peer educator provides the community members living with diabetes with reliable information including basic skills. People with diabetes are thereby assisted to become informed consumers of health services, including health insurance covering their needs.A peer educator is a lay person who lives in the local community, has diabetes and has been trained by MoPoTsyo.In total, 18 peer educators will be identified among community members. Initially, 4 already identified candidates will undertake training as a peer educator.The peer educators are trained in self-management of diabetes to ensure that they practice what they preach. The focus is on self measurement of glucose levels and adaptation of life style, including nutrition and daily exercise. Self measurement of glucose levels is done by means of urine strips and as part of the training the candidate is regularly visited at home to see how s/he is doing, provided with additional urine strips and explanations in order for the individual to become familiar with self measurement and interpretation of results. Progress is recorded in a personal patient follow-up booklet.Eventually, the peer educators will be trained on how to train other people and how to counsel other people through formal training and on-the-job training. The first 4 peer educators will go to Phnom Penh for 3 months to assist the peer educators from the already operating urban peer educator project run by MoPoTsyo. Here they will become familiar with a large number of diabetes cases as well as the service at Kossamak National Hospital.The peer educators should organise weekly sessions for people with diabetes who have been registered recently, who are not well controlled or not successfully self managing.The peer educators will then receive a kit that contains the materials they need in order to fulfil the role as a peer educator.The intention is for the peer educator to become the known person in the community to whom people will turn if they suspect they have diabetes. Initial testing may then be done using a urine strip. The peer educator should also deliver key messages about diabetes to all households in the community.A Diabetes Programme Manager will monitor and supervise the peer educators.
• One peer educator was established in each of 10 Health Center coverage areas of Ang Roka OD• 557 people detected with diabetes, 72% of whom did not know they have diabetes before the screening by MoPoTsyo• Average cost to the diabetes patient of living with disease reduced to less than USD 5 per month