Promotion of diabetes associations, Sudan

Objectives

Diabetes is a growing problem in all socio-economic groups both in the North and the South of Sudan. As a consequence of the past and ongoing conflicts in the country the health care system has been severely disrupted and does not have the capacity to deal with chronic diseases. Furthermore, the vast distances and poor infrastructure contributes to low coverage and expensive care facilities.

WDF has supported eight projects in Sudan so far, and considerable progress has been made to enhance accessibility and improve quality of care. However, in many areas there is still a lack of access to information and support systems due to shortage of human and financial resources and an overemphasis on clinical care. The National Health Policy (2007) accentuates community participation as a basic right and an essential principle of health development. Community involvement of civil society is imperative to shaping the quality of health care services and the responsiveness of the system. Because of the size of the country and the huge demographic, socio-economic, ethnic and religious variations, community participation is particularly important for being able to provide sustainable, quality care to everybody. However, civil society is not yet geared to voice the needs and concerns of people living with diabetes. Only a few diabetes associations exist, and the ones that do, do not have the capacity or the financial resources to function efficiently.

The aim of this project is to promote diabetes care through strengthening of civil society by establishing and empowering diabetes associations in the regions of Khartoum, North Nile, Gezeira, Sennar, Kassala, Gedarif, Red Sea, White Nile, North Kordofan, South Darfur and Bahr al Jabal.

Approach

Diabetes Programs Promotion Organisation (DPPO) is an action group of health professionals who have come together to enhance diabetes care and prevention in Sudan. Its mission is to advocate for the provision of quality diabetes care for all. The diabetes associations (DAs) have a vital watchdog role and can be powerful advocates to promote and protect the rights of people living with diabetes. One of DPPO's goals is to improve the capacity of the regional DAs in order to improve the quality of life for people living with diabetes.

This current project wishes to strengthen civil society by offering capacity building to four existing DAs in four states. In addition, eight new DAs in eight other states will be established. The DAs are expected to form smaller branches (Societies of Diabetic Community - SDCs) in three districts in the catchment area within the first six months. These branches will again form new sub branches. It is expected that before the end of the project approximately 100 SDCs will be created. In addition to voicing the needs and rights of people living with diabetes, the DAs and SDCs are expected to run advocacy and awareness activities and to assist the public health care sector in the development of health facilities.

Small laboratories will be established in each of the 12 DAs offering a wide range of screening and monitoring tests. In addition to providing vital tests for diabetes management, the laboratories are intended to function as income-generating activities. In combination with small membership fees they will act as alternative methods of sustainable funding. The profit generated by laboratory services will subsidise services available to members of the DAs and for poor patients unable to afford the services.

Education of the local community will be organised by educators through training sessions, home visits and local mass media using training materials developed in a former WDF-supported project, WDF06-181. Building upon structures created in previous WDF-supported projects in eight different states, DPPO will establish four referral clinics in secondary level public health hospitals in four new states (Kassala, Gedarif, Red Sea State and the Western part of South Darfur). The Ministry of Health (MoH) will provide equipment and staff to the clinics, and medical staff will be trained in diabetes management to optimise quality of care. This expansion is also a means of bridging the gap between North and South and is in line with a post-conflict reconstruction which set out clear principles for better health as a way of re-establishing peace, trust and legitimacy.

Results at completion

• Establishment of 12 diabetes associations
• 12 good quality labs were established
• 81 Doctors, 65 Educators and 35 laboratory technologists were trained
• Establishment of 4 diabetes clinics
• 20,000 people with diabetes educated
• 200,000 people reached by awareness activities