According to the World Health Organisation (WHO) Malawi has a high prevalence of diseases such as tuberculosis, malaria, HIV/AIDS and other communicable tropical diseases. Furthermore, evidence suggests that there is a growing burden of non-communicable diseases. It is estimated that 33 % of adults have hypertension and 5.6 % of the population lives with diabetes. Most chronic diseases are managed in central or district hospital out-patient settings. The majority of patients receive care only when they attend health facilities. There is no structured care to record, monitor and follow up cases: and treatment and drug supply is erratic resulting in poor outcomes.The objective of the project is to set up diabetes clinics in 3 districts in Malawi, provide training for health care providers and raise awareness of diabetes among the general population.
Baobab Health Trust was founded in 2000, and is a registered local NGO. Baobab's Vision is to lead the improvement of health through information and communication technology in the developing world. Baobab's mission is to achieve this by building, deploying and maintaining innovative, robust and sustainable health care information systems suitable for the developing world in collaboration with government and health care workers. The Baobab Health Trust will implement the project in close collaboration with the Non-Communicable Diseases and Mental Health Unit in the Ministry of Health, Malawi; Lilongwe District Health Office, the Kamuzu Central Hospital and the International Union Against Tuberculosis and Lung Disease (The Union).In 2010 the WHO developed a package of essential non-communicable (PEN) disease interventions for primary health care in low-resource settings. However, there is limited evidence documenting piloting of the proposed package in an integrated manner in low-resource settings. The proposed “Chronic Care Clinic” strategy will act as one of the ways of piloting the WHO PEN and therefore creating a platform for generating evidence for scale-up. A touch screen based electronic medical records system already in use at the Queen Elizabeth Central Hospital Blantyre (WDF project number) will be used to strengthen monitoring of patient outcomes. The lessons drawn from this pilot will inform the Ministry of Health in standardising management of key non-communicable diseases based on the WHO PEN guidelines. The piloting of Chronic Care Clinic will take place at a time when the Ministry of Health in Malawi is trying to strengthen coordination of care and support for patients suffering from NCDs.Chronic care clinic for key non-communicable diseases will be set up in Kamuzu Central Hospital and one in Area 25 Health Centre in Lilongwe, and both will offer their services 2 or 3 days per week. The clinics will be the basis for the provision of long-term chronic care and treatment for key non-communicable diseases. Senior medical officers, nurses and medical assistants will be trained to manage the clinics and provision of drugs and supplies for management of patients will be given to the clinics. The dispensation of drugs will be integrated in the routine health facility system at the clinics. Patient education videos will also be developed in collaboration with Health Education Department including thematic areas as signs and symptoms of diabetes, prevention of diabetes, management of diabetes etc.Quality of clinics will be assured through supervision and support by medical officers from Lilongwe. In order to kick-start the services in the clinics basic equipment will be procured through Baobab Foundation.The project will also monitor all registered cases and their treatment outcomes by using an Electronic Medical System, built on an existing system that is fully functioning in Blantyre Malawi.As a pilot the project will contribute to the strengthening of the information system for the Non-Communicable Diseases’ Programme in Malawi by submitting quarterly reports on cases, treatment outcomes and quality of care.
• 2 chronic care clinics established• 7,856 patients registered at clinics and receiving care• Electronic Medical Record system set up at 2 clinics• Standard guidelines and treatment protocols for NCD developed • Patient education material developed and adopted by the Health Education Unit in the Ministry of Health• Ongoing monitoring, treatment and education of patients carried out