Diabetic foot: Northern coastal , Peru

Objectives

The majority of the population in Northern coastal Peru is living in poverty and access to health care services is limited, especially for people living with chronic diseases, such as diabetes. In 2005 the General Act for the Protection of People with Diabetes was passed, and since 2008 diabetes medication has become exempt from taxes. However, implementation of other directives contained in the Act is delayed, and there is still a long way to go in terms of providing services to everybody living with diabetes.

Peru is still battling a huge burden of communicable diseases like malaria, TB and dengue. Thus, non-communicable diseases (NCDs) do not appear high on the priority list of the Peruvian Ministry of Health (MINSA). IDF estimates that diabetes prevalence is 5.6% and rapidly rising, which makes prompt action essential.

Currently, diabetic foot care does not exist in the areas covered by the project, neither in the public nor the private sector, and complication rates due to diabetic foot ulcers are alarming. Diabetic foot care is improvised, uncoordinated and lacks assessment protocols.

The aim of this project is to establish diabetic foot care and to promote prevention of foot complications in two Northern coastal regions of Peru: Lambayeque and La Libertad regions.

Approach

In light of the situation, APROVIDA emerged in 2006 as an NGO formed by health care professionals and diabetes patients. The aim of the organisation is to offer comprehensive diabetes care, stressing the importance of education and patient self-management.

As the implementing partner of this current project, APROVIDA wishes to establish diabetic foot care at selected health facilities and to scale up efforts to prevent complications. It builds upon a regional foot project in Bolivia, Columbia, Ecuador, Venezuela and Peru (WDF05-135) which targeted some provinces of Peru and facilitated an emerging attention to diabetic foot complications in MINSA.

The project is embedded within and supported by regional health departments and by the Peruvian Health Insurance System, which ensures the anchoring of project outcomes in public health structures after project completion.

The project will offer capacity building to 35 health facilities located in seven different provinces of the two regions, covering various levels of the health care system. The selected clinics will be strengthened by providing basic foot care equipment and educational materials, as well as by offering diabetic foot training to one doctor and one nurse from each clinic. These health care providers will be trained as trainers and are expected to pass on their knowledge to an additional number of health care providers. Both the basic and advanced courses of the Step-by-Step training model will be applied.

The catchment population of the targeted health facilities is estimated to be one million people, out of which the project is expected to reach 11,000 people living with diabetes. Each patient will go through a medical consultation, and will subsequently attend a training workshop in self-management.

Results at completion

•31 diabetic foot service units established
•Educational materials for patients produced
•196 doctors and 239 nurses attend Step-by-Step courses
•6 project coordination/awareness visits conducted
•Training replication of an additional 70 health care providers