Executive summary :
The Swasthya Diabetic Care and All India Institute of Diabetes and Research along with Indian Institute of Public Health, Gandhinagar initiated a project funded by Bristol-Myers Squibb Foundation (BMS foundation), named Conquer Diabetes in selected area of Gujarat and proposed to test model on a pilot basis to provide care to poor diabetic patients and spread awareness in the communities in three different settings in Gujarat state.
Project was successfully launched on 16th September 2012, and whole country noticed the same through media (television and newspaper). The project was formally approved by Government of Gujarat on September 11, 2012 and issued a support letter to all concerned key officers for implementation of Conquer Diabetes Project on December 21, 2102. Successful establishment and use of low cost modern technology (Skype) was demonstrated in the project for post training assistance of medical officers in management of diabetes. Data related to diabetes was not recorded / maintained before commencement of project in any of intervention areas. Project was successful in establishing the system of diabetes related data maintenance at all centers. There is increase in flow of data related to diabetes and other available facilities related to management of diabetes at PHC (Primary Health Centre) / UHC (Urban Health Centre). From second quarter (i.e. July 2013) onwards, all facilities in AMC, Mehsana and 12 of the 16 facilities in Chhotaudepur reported diabetes related data regularly.
During project intervention total 177 doctors and 1260 paramedic staff received training in various aspects of management of diabetes. After completion of training, medical officers were more confident in treating diabetic patients and whenever required they got expert’s support from Swasthya Diabetes Care through use of Skype. There was intense effort in developing IEC and displaying at appropriate places. The IEC focused on early diagnosis and management of the type2 diabetes. It was documented that IEC activities had increased awareness in community regarding availability of treatment at the PHC to pro-actively enquire and seek appropriate care.
Before the implementation of project, community participation was weak with public health system but with inception and roll out of project the community participation improved. Due to our continuous efforts of CDP in the field, people have started utilizing facilities available at PHC more efficiently. There is an increase in number of people attending OPD and investigation done. Number of newly detected diabetic cases and follow up diabetic cases attending PHCs / UHCs also increased. In majority of centers total diabetic visits improved tremendously upto 400% during the project as compared to baseline of project. The number of blood sugar test increased in majority of centers. Overall, total laboratory testing for blood sugar monitoring has improved by more than 250% at study sites. Conquer Diabetes Project is successful in reaching and providing diabetes care facilities to 25713 patients over a period of 2 years.
IEC activities carried out during project were successful in raising awareness in diabetes patients and general community. There is 30 to 40% improvement in knowledge related to various parameters of diabetes such as causes, complications various modes of diabetes control etc.
Project has also documented one novel initiative in providing diabetes care through a grass-root level partnership between Primary Health Centre, and village level Non-Governmental Organization (NGO).
There was non-availability of anti-diabetic medications in all centres. Additional Director, Health Services, Government of Gujarat has issued a letter to all Regional Deputy Directors in Health Department of the Gujarat state and recommended to make medicines available for Diabetes and Hypertension in all PHCs/CHCs of Gujarat state. Doctors have started putting requirement for medicines to Health department of Government, or they purchase the medicine from the local Fund (RKS) available to them for distribution among patients. Conquer Diabetes project (CDP) team is assisting Government to initiate training of other health care professionals in management of diabetes and other NCDs and Government has adopted the training module of Conquer Diabetes Project. Team CDP had also received the request from Ahmedabad municipal corporation (AMC) to train all Medical Officer of AMC, which was later completed. There is also a demand for IEC materials developed under Conquer Diabetes Project from different Stakeholders.
During the project one member of CDP was regularly invited in the Non-Communicable Diseases (NCD) meeting of Technical Advisory Committee of Health Department, Govt. of Gujarat to assist in effective planning and roll out of training program in the entire state. The Government has also requested team CDP to evaluate and triangulate the data collected and available with state regarding Diabetes Projects and make recommendations for further action.
The intense advocacy has resulted in convincing Govt. of Gujarat to make specific budget allocation for management of diabetes among all Non- Communicable Diseases. A GR has also been released utilizing ASHA worker for diabetes screening on incentive basis.