In Honduras with a population of 8,04 million, 38 % are under 15 years (WHO) and in 2010, 59 % of the population lived in poverty and 36 % lived in extreme poverty (World Bank). With growing urbanisation, Honduras is experiencing a great surge in urban poverty.. Honduras has an estimated national diabetes prevalence of 5,41 %. As in many other developing countries, the public health system is oriented towards acute curative care and not chronic care. According to the National Health Survey of 2005-2006 there has been an increase in overweight children from 3,1 % in 2001 to 5,9 % in 2006 and an even more rapid increase in overweight and in obesity in women aged from 15-49 years from 26 % in 1996 to 47 % in 2006. In a PAHO study from 2009 one third of the population had problems of overweight and one in five of obesity. Those most affected were over 40 years of age. This correlates with an increased diabetes prevalence of 7,9% among persons over 40 years of age. Similarly, rates of hypertension are also very high. It is therefore essential to develop interventions that improve access to health services for the population and increase the focus of both the population and the health sector on chronic non-communicable diseases.The aim of the project is to ensure access to prevention and control of diabetes and its complications. This will be done through patient-centred care for people with diabetes and by health promotion among patients, families, people at risk, community leaders, teachers, health employees and companies.
The project model builds directly on the outcome of a previous WDF supported project (WDF06-171) which targeted four countries in Central America. The project is a collaboration between PAHO/WHO, the Ministry of Health and WDF. The project will be implemented in 8 health units of the Honduran Ministry of Health and 6 of the Honduran Social Security Institute. The Ministry of Health will have a steering role and will establish the regulatory and operational bases, as well as define and validate the monitoring subsystem of the project in order to obtain information and issue recommendations. PAHO/WHO will administrate the execution of the project and provide the technical support for the training of the national resources to lead the planned activities and initiatives, and improve the quality of care in the health units.The project will be located in selected municipalities of the country’s two largest cities, Tegucigalpa and San Pedro Sula which have the highest concentration of people living with diabetes.The project aims to improve access for the population to integrated programmes for prevention and control of diabetes and associated complications. The project wishes to develop a minimum package of interventions based on the 2009 PAHO study experience and on the package of essential chronic non-communicable disease interventions of the WHO in 15 health units of the Ministry of Health and Social Security Institute. This includes strengthening of the integrated response to patient emergencies and complications in 4 hospitals.The project plans to organise training workshops for community health care workers, and provide basic materials and equipment to implement integrated diabetes management. Additionally, the project plans to organise training workshops to strengthen multidisciplinary teams in the 4 hospitals of the health units for the integrated management of care for diabetes patients, acute crisis, complications and/or co-morbidity. Finally the project wishes to design health promotion materials and run several kinds of educational activities for patients, family, teachers etc.The project will continuously evaluate the process and impact of the interventions.
• National diabetes care guideline and training manual developed and endorsed, and applied at all national level training institutions• National multisectoral committee on NCDs established• 728 doctors, 1,157 nurses and 850 other health care personnel, incl community health workers, trained within integrated diabetes management incl. complications and co-morbidity• 14 clinics and hospitals provided equipment and capacity building to provide improved care for diabetes and other NCDs• Medication for diabetes and other NCDs included into the national essential medicines list• More than 32,000 diabetes patients accessed improved care at the targeted clinics and hospitals• Comprehensive patient education rolled out and more than 30 patient support groups established