Agents for change II, South Africa

Objectives

South Africa has an estimated diabetes prevalence of 4.5%. Many health care providers admit themselves that they know very little about diabetes, are scared to nurse diabetes patients and unaware of how complications arise and how they should be treated. In addition, the majority of HCPs are overweight, and up to 20% have diabetes themselves. Furthermore, there is a deep-rooted stigmatisation of diabetes patients because of persistent myths about the disease.

Many doctors are therefore ill-trained in terms of providing timely diagnosis as well as proper care and management. As a result, patients experience a lack of trust in the system, leading to extremely low rates of adherence to treatment and follow up. Consequently, the majority of patients experience prolonged elevated blood sugar levels and frequent complications.

There is a need for changing the mindset of health care professionals from the acute model of patient care to a more holistic, long-term and empathetic chronic care model.

The aim of the project is to improve diabetes care and management by changing attitudes and improving skills among health care professionals in eight out of nine provinces of South Africa.

Approach

This project is a replication and in a sense continuation of the WDF-supported project Agents for Change I, WDF08-378 implemented in four South African provinces between 2009 and 2012. The first project has achieved very promising results in terms of increased knowledge-levels, improved care and lower complication rates, as well as higher patient satisfaction.

This current project is a collaboration between Diabetes South Africa (DSA) and the Department of Health. It will target eight out of the country's nine provinces. The remaining Mpumalanga Province received specific attention during the previous project.

The project seeks to utilise the health workers' own health profile as a starting point for changing attitudes and behaviours towards diabetes patients. They will thus be provided with the skills to change their own health, which is a prerequisite for motivating their patients.

270 health care workers from disadvantaged, rural areas throughout the country will undergo a series of training sessions with the aim of sensitising them, increasing their knowledge, inducing behaviour change, and changing their attitudes towards diabetes. The participants will comprise a variety of HCPs usually dealing with disadvantaged patients - including primary physicians, nurses, health promotion assistants, dieticians, pharmacists, therapists and community leaders.

The project consists of two teaching models both employing a participatory approach using role plays, motivational techniques etc.:
1. "Agents for Change" course
2. "Empowering the Patient" course

During the course of the project, nine multidisciplinary groups of 30 health professionals will undergo a two-day training session on patho-physiological aspects of diabetes, detection and management, medication, nutrition and lifestyle education, communication skills etc.

Six months later, the same team of health care providers will undergo a two-day refresher and follow-up course on the same topics covered in the first session, but now focusing on providing tools for empowering patients and applying effective diabetes management and education.

Each of the 270 trained HCP will be made responsible for disseminating their knowledge to ten of their colleagues. Moreover, they will be encouraged to form support groups among their diabetes patients. It is expected that approximately 10,800 people will benefit from improved care and support.

It is envisioned that the training modules will be incorporated into the mandatory curriculum of health worker teaching facilities throughout the country.

Results at completion

• 17 doctors, 378 nurses and 280 other health/community workers trained on diabetes prevention, care, management and patient education
• More than 3,000 colleagues have been trained on diabetes assessment and follow-up by the trained health workers
• At least 31,000 people with diabetes or at high risk reached through improved care and support