With a prevalence of more than 10%, diabetes constitutes the leading cause of morbidity and mortality in Mexico. National data indicate that up to 30% are unaware of their condition, resulting in high complication rates and premature death. The main risk factors for diabetes are extremely widespread and continue to increase, with two out of three adults currently being overweight or obese. The fastest increase in type 2 diabetes incidence is seen among adolescents. Diabetes exerts an enormous burden on individuals and on the health care system.The National Health Program 2007-2012 recognises the importance of addressing the rising burden of diabetes throughout the country, and particularly along the northern border, where huge social inequalities in access to health care services exist. Cultural diversity is also an important issue that needs to be properly addressed if behaviour change is to be achieved. The aim of the project is to improve primary care and prevention amongst vulnerable persons with or at risk of diabetes in two Northern Mexican communities (Tijuana and Ciudad Juarez).
The project is initiated by PAHO in cooperation with the Mexican Secretariat of Health (SSA), which is one of the main public health care providers in Mexico. The project is aligned with the National Health Programme strategy 2007-2012 and with the PAHO US-Mexico Border Office priorities concerning diabetes. An advisory board consisting of collaborating universities will be established to provide scientific input to the project.The project will employ a comprehensive, culturally appropriate, approach combining clinical care and diabetes education to people living with or at risk of diabetes, including their families. The goal is to improve care, self-management and to reduce complication rates as well as diabetes incidence by inducing behaviour change.Clinical and non-clinical services will be provided to 600 registered patients and to 70 people at risk. This target group is selected from the most vulnerable segments of the population, who have limited resources and access to health care. Enrolment in the project will be free of charge.Capacity building will be provided to eight public primary health centres in Tijuana and Ciudad Juarez through provision of equipment and in-depth training of 60 community health workers. The community health workers are intended to empower communities, patients, people at risk, and their families to lifestyle changes and improved self-management, as well as to facilitate access to primary and secondary prevention programmes. Health and nutrition classes will be conducted twice a month, while physical exercise activities will be carried out daily in combination with monthly education classes. Education in self-management will be provided to people living with diabetes. In terms of clinical care, half-yearly medical check ups, including eye and foot examinations, will be provided to all enrolled patients. Compliance with medical appointments, treatments and behavioural recommendations will be ensured by conducting home visits.To support the primary prevention efforts, community activities will be carried out to raise awareness among the general population.A comprehensive evaluation containing anthropometric and behavioural as well as qualitative measures will be carried out to assess project impact. The model of diabetes prevention and care applied in this project is envisioned to be used in other Mexican and/or Latin American border areas.
•A new community health worker’s (CHW) manual for NCDs/diabetes care and prevention was developed and endorsed by Mexican health authorities, and published as an official PAHO guideline for community health workers in the PAHO region.•A ’Border Diabetes Partner forum’ was established across the two states targeted through a ‘Centre of Excellence’ structure consisting of leading stakeholders including universities and health authorities.•A total of 85 community health workers, linked to eight community health centres, were trained using the new manual; in addition, ten doctors and 12 nurses working at the eight community health centres (primary level clinics) were trained and involved in project implementation. •A total of more than 700 patients were targeted through the various project activities including education and awareness sessions, repeated clinical consultations incl measuring of BMI, HbA1C and subsequent follow-up through home visits.•A project website was created but was deactivated given the closure of the PAHO US-Mexico Border Office closure.•As an official PAHO guideline, the new CHW manual would be promoted further in Mexico, including through project WDF14-913 (recently approved), and possibly elsewhere in the PAHO region.