Comprehensive care of diabetes and hypertension to reduce maternal mortality, Brazil

Objectives

To roll out first phase of a state level programme in Maranhão State concerning diabetes, hypertension and hyperglycaemia in pregnancy, with emphasis on capacity building at primary care level.

Approach

The project activities include:

Preparation of primary care and referral units within targeted areas through sensitisation and coordination with local municipalities and health authorities; Preparation of training material/guidelines etc.
Capacity building of health facilities targeted through comprehensive and differentiated trainings of various HCP categories within screening and provision of care for diabetes and hypertension and hyperglycaemia in pregnancy, and incl. foot care and eye care.
Provision of various equipment to all facilities, mainly consisting of a comprehensive ‘basic kit’ to each primary level unit targeted.
Implementation of awareness, health promotion and screening activities out of the targeted primary care units incl. through mobilisation of surrounding communities, schools etc.
Institutionalisation of cross-referral system between the units and with the referral care centre in the state capital.
Rolling-out of a comprehensive monitoring and evaluation framework incl. frequent on-site visits and strengthened patient registries.

Expected results

1,000 doctors, 1,000 nurses and 2,000 HCWs trained.
335 primary care facilities and three referral unit provided capacity building
86 ‘family health teams’ provided additional capacity within diabetes and pregnancy.
36,000 diabetes known/newly detected cases and 70,000 hypertensive cases provided improved care.
36,000 pregnant women screened for GDM with at least 3,000 cases diagnosed and provided improved diabetes/pregnancy care.
An overall catchment population of 900,000 (14% of total Maranhão State population) and 20% of all care facilities in the state targeted.