Increasing access to multidisciplinary diabetes care, Philippines

Objectives

As of 2011, 49 % of the population in the Philippines were living in urban areas and this number is expected to increase to 70% by 2015 according to the WHO. With the increased urbanisation follows a rising wealth, increasing consumption and more sedentary lifestyles, which combined with inequality in access to healthcare presents a major challenge to public health and has become one of the key drivers behind the acceleration of diabetes prevalence in the country. According to IDF the Philippines will be one of 10 countries with the highest number of diabetes cases by 2030.

Handicap International took on the challenge of closing the gap between the existing national NCD framework and the needed services for NCD prevention and control in Davao city. Diabetes care was thus improved through a 3-years pilot diabetes project from 2007 to 2009 - with emphasis on preventive foot care and rehabilitation. Based on this experience, the cardiovascular disease (CVD) project was launched, to promote a multidisciplinary and integrated approach to care for people with CVD risk factors and diabetes.

Foot care education and risk assessment are part of the routine health services of the CVD program but according to the monitoring report, these services needs to be improved. Health care professionals (HCP) need to develop technical and operational skills in preventive foot care and management of chronic wounds.

The aim is to improve multidisciplinary diabetes care and prevent foot complications.

Approach

Diabetic foot care services in Davos city’s public health care system will be strengthened as part of the project. Educational material for patients will be developed with special attention to the local context and made available throughout Davos city.

Training materials and tools like registries, records and screening forms for HCP will also be developed and made available along with wound care kits at clinics in Davos city in order to standardize and structure services.

HCP from district health centres will be trained by specialist teams on the Step-by-Step model in order to set up foot clinics in the district health centres. Training will have special focus on chronic wound care and foot ulcers. A monitoring team will ensure quality of treatment and program sustainability. Advanced training will be set up as training of trainers to increase sustainability and quality. The first training of HCP will last for 5 days and the second one for 2 days.
Once the project is rolled out across Davos city, three new cities will be selected for implementation of the project.

Results at completion

• 57,242 people screened for diabetes and hypertension
• 16,441 patients screened for diabetic foot
• 1,378 feet saved through treatment
• 48 health care centres strengthened on diabetes care
• 25 doctors, 66 nurses ad 689 health care providers trained on diabetes and diabetic foot care.