World Diabetes Day: A Health-Systems Approach to Protect Our Future

World Diabetes Day: A Health-Systems Approach to Protect Our Future

 {Photo credit: Warren Zelman}Democratic Republic of CongoPhoto credit: Warren Zelman

November 14 is World Diabetes Day. This year’s theme, “Protect our future,” emphasizes the importance of engaging and inspiring local communities to promote awareness and education on the effects of diabetes and its preventable risk factors. 

Suffering from chronic fatigue, weight loss, and repeated infections, twelve-year-old Hadija had made frequent visits to the national referral and teaching hospital in the capital city of her Sub-Saharan African country. At first, doctors presumed she had HIV, testing both her and her parents. Then physicians looked for cancer. After several follow-up visits and investigations, the physicians tested for and confirmed that Hadija had type 1 diabetes. 

Despite finally arriving at an accurate diagnosis, the hospital struggled to track down and provide the next key ingredient Hadija needed: human insulin as treatment for her disease. Eventually, Hadija was fortunate that her doctors were able to get her the needed treatment in time and that a health care provider and patient support group, along with community volunteers, were able to help her adhere to treatment. Other children have not fared as well.

Think diabetes is a problem of the rich and developed countries? Think again. 

In low- and middle-income countries, today’s lack of access to insulin mirrors the lack of access to life-saving antiretrovirals (ARVs) almost two decades ago. Nearly a century after its discovery in 1920, life-saving insulin is largely inaccessible in many parts of sub-Saharan Africa, which leads to increased risk of death and suffering among those living with diabetes. 

Recognizing the gap in services and lack of access to life-saving interventions, MSH has joined the global community in saving lives of those affected by diabetes by strengthening all levels of the health system.

Through the USAID-funded Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT-CS), MSH is exploring the inclusion of gestational screening for diabetes in antenatal care in Amhara/Tigray Regions of Ethiopia.

In Kenya, in collaboration with the Ministry of Health (MOH) and World Health Organization (WHO), MSH’s Strengthening Pharmaceutical Systems (SPS) program has developed clinical governance documents. Once launched in 2010, the national Standard Clinical Guidelines (SCGs) and the Kenya Essential Medicines List (KEML) were disseminated to health facilities nationwide with the help of the Health Commodities and Services Management (HCSM) Program, through an award by USAID/Kenya.

HCSM is also developing an insulin tracking tool to help push an insulin management policy forward and providing support to people with diabetes in the context of continuum of care from patient, health facilities and back to the patient. 

At MSH, we empower individuals to make decisions about their health and make healthy lifestyle changes, train health workers who administer essential services, and engage government officials and policy makers who influence standards and allocate resources. We believe an integrated health systems approach—coordinating and integrating health services across all sectors and levels of care—is the best way to address the growing challenge of chronic disease and co-morbidity of diseases, such as diabetes and HIV and diabetes and tuberculosis (TB). 

For countries already experiencing high rates of infectious diseases, notably HIV/AIDS, tuberculosis (TB), and malaria, chronic diseases like diabetes threaten to create a double burden on already weak health systems with limited human resource capacity. Globally, a person with diabetes is two to three times more likely to contract TB. We are working with partners in Tanzania and Ethiopia to better understand the burden of TB and diabetes in hopes of developing guidelines for diagnosis and co-management of the diseases. 

In Tanzania, MSH is partnering with the USAID-funded TB-IQC Project, led by PATH, to conduct a needs assessment on the implementation of collaborative TB and diabetes (TBDM) control activities in three selected PATH-supported regions. The assessment, conducted by MSH, focuses on two key areas: the epidemiological pattern of TBDM in selected regions/districts and current practices in TBDM diagnosis and co-management. MSH will use the results to develop TBDM guidelines specific for Tanzania.

Through the USAID-funded Help Ethiopia Address the Low TB Performance (HEAL TB Ethiopia), HEAL TB/MSH will be conducting operational research on TB and diabetes. The aim of this study is to determine the magnitude and determinant factors of pre-diabetes and diabetes among rural and urban TB patients and healthy adults in Ethiopia. The working hypothesis is that, if the magnitude of diabetes is high among TB patients in Ethiopia, an Ethiopian-based TBDM intervention will be designed to address it.

The health and economic effects of diabetes can be devastating. In 2012, 4.8 million people died from diabetes and an estimated $471 billion was spent on the associated health care costs. Families and governments alike bear the burden of these costs through high out-of-pocket health care expenses, disability, and lost productivity and absenteeism among those who are of working age.

To reduce out-of-pocket spending and improve access to health services for all, MSH supports universal health coverage for all. To improve and ensure access to quality services, we are working to improve models of service integration, strengthen laboratory services and referral systems, and gain political and public commitment of UHC.

To protect young people and their futures in low- and middle-income countries, we must advocate for the removal of financial barriers to access quality care, diagnosis, and treatment and for improved financial risk protection for all using the Universal Health Coverage framework as one of the solutions in addressing chronic diseases including Diabetes. Patients like Hadija and others will benefit from policies linked to UHC with contributions of all sectors (public, civil society, and private), that acknowledges and involve beneficiaries like herself in the design and implementation of the programs. 

Today, on World Diabetes Day, please help spread the message: Protect our future. Protect all of the Hadijas around the world. Diabetes doesn’t have to be a life sentence, like HIV & AIDS was before ARVs were widely available. Through a whole health-systems approach – including training health workers, better leadership, management, and governance, ensuring access to medicines through universal coverage and pharmaceutical systems strengthening, and developing innovative and integrated services at the point of care – we were able to save Hadija and will save many more around the world. 

Colin Gilmartin, Technical Officer, contributed to this post.

Gloria Sangiwa, MD, is Management Sciences for Health’s global technical lead for chronic diseases and the director of technical quality and innovation in MSH’s Center for Health Services.