National service framework for diabetes, Mauritius

Objectives

The prevalence of diabetes in Mauritius is one of the highest in the world. Nearly 20% of the population above the age of 30 years and nearly one in two of those above 50 years suffer from diabetes.

Despite government health services being free of charge at all levels, only 17.3% of diabetes patients have a good glycaemic control.

The situation has been worsened by a recent economic setback, which puts a serious strain on the available resources for health care in the country.

Nevertheless, the Mauritian government has decided to put particular emphasis on diabetes care and it has now initiated the implementation of a National Service Framework for Diabetes.

The project supports implementation of 3 out of 10 components in the National Service Framework for Diabetes in the Mauritian health care system.

Approach

Located in the Indian Ocean around 800 km south-east of Madagascar, the Republic of Mauritius is a small island nation with approximately 1.2 million inhabitants.

With a very high prevalence of diabetes in the country, the Ministry of Health and Quality of Life has adopted a National Service Framework for Diabetes outlining strategies for primary, secondary and tertiary diabetes prevention and care with the interventions required for them to be achieved.

The National Framework contains a total of 10 components:
1. National sensitisation and awareness campaign
2. National diabetes empowerment programme
3. Nutritional and physical activity action plan
4. Registration of all people with type 1 and type 2 diabetes
5. Provision of insulin pen-like devices for children with type 1 diabetes
6. National retinal screening programme
7. Podiatry services
8. Provision of self-monitoring blood glucose meters to all pregnant women with diabetes
9. Surveillance for diabetes complications
10. Strengthening laboratory services.

WDF supports the efforts of the Ministry of Health and Quality of Life by funding implementation of components 4, 6 and 7 of the Framework. Other donors/agencies as well as the Mauritian government are expected to cover the cost of implementation of the remaining components.

All running cost in terms of staff and facilities will be covered by the Ministry of Health and Quality of Life.

Component 4: The setting up of a national register of all patients with diabetes is estimated to take 3 years.

Data on people with diabetes will be collected at the health centres and then gathered and registered at regional level health facilities. From these facilities, computer connections to the Ministry of Health and Quality of Life headquarters will be established.

At headquarter level, data from all five regions of the country will be compiled. In order to prevent duplication in registrations, the national identity card ID number will be used in the registration process.

Component 6: Under the national retinal screening programme, retinal cameras will be made available at regional level and photographers and graders will be trained.

Diabetes patients attending the health centres will be referred to the regional hospitals for retinal screening on an annual basis.

The patients in need of treatment will subsequently be referred and treated accordingly.

Component 7: Podiatry services will be established through the training of 120 nursing officers and 120 doctors in the provision of foot care. Orthopaedic teams will be trained in contact casting and other pressure-relieving methods.

Upon completion of the training, the health care personnel will be working at diabetes clinics at the regional level, providing podiatry services to diabetes patients.

Nurses will inspect feet for ulcers and other problems and educate patients in prevention of diabetic foot problems, while doctors will screen for neuropathy and vasculopathy.

Patients at risk of diabetic foot problems will be attended by a podiatrist and the more serious cases will be referred to the regional hospital for treatment.

Results at completion

- A national registry of diabetes with over a 100,000 people
- 102,863 diabetes patients undergo regular foot examinations
- 67,027 patients screened for diabetic retinopathy
- 307 health care providers including nurses, doctors and surgeons havebeen trained in diabetic foot care