Stay Super. Beat Diabetes with Health Systems Solutions: World Health Day 2016

Stay Super. Beat Diabetes with Health Systems Solutions: World Health Day 2016

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Today, April 7, we celebrate World Health Day, started by the World Health Organization (WHO) to mark its founding in 1948.

Amid Ebola, Zika, maternal and child mortality, and other global health challenges, WHO chose diabetes, for the first time, as its World Health Day theme (“Stay super. Beat diabetes”).  To urge global action on the rising diabetes burden, WHO released a new global report yesterday, April 6, highlighting key global diabetes findings, country profiles, and recommendations to reach the Sustainable Development Goal (SDG) target 3.4, which calls on countries to reduce premature death from noncommunicable diseases (NCDs), including diabetes, by 30 percent by 2030. 

Why is addressing the global rise in diabetes urgent?

In 1901, diabetes was unheard of in sub-Saharan Africa. In 2014, an estimated 22 million people lived with diabetes. By the year 2025, more than 75 percent of people with diabetes will be in low- and middle-income countries. By 2035, the International Diabetes Federation (IDF) estimates that more than 42 million people will have the condition.

The health and economic burdens of diabetes -- and its anticipated continued rise globally in resource-limited settings -- are, and will continue to be, catastrophic.

Because diabetes progresses slowly and requires lifelong care, the disease can bankrupt families, as well as damage the economies of nations. People in low- and mid-income countries, especially in  sub-Saharan Africa, are especially vulnerable to diabetes, since many lack access to prevention, early detection, and treatment services. Urbanizing societies are at particular risk as individuals adopt sedentary lifestyles and poor diets. Diabetes causes the highest percentage of premature deaths of any region in Africa: 75 percent of those deaths will be in people under the age of 60. Nearly two-thirds (63 percent) of cases of diabetes in Africa go undiagnosed.

How can developing countries “stay super” and beat diabetes?

Address diabetes through a patient-centered, integrated health-systems approach that starts by filling major gaps between what is known to be effective, and what is done in practice.

  1. The first health systems entry point is addressing gestational diabetes (GDM), which affects pregnant women and is an often-overlooked cause of maternal and infant deaths and poorer health outcomes. GDM also significantly increases the risk for mother and newborn of type 2 diabetes. For starters, this means working with countries and health facilities to integrate GDM screening into prenatal care. After identifying GDM, pregnant women can be advised to modify their diets and incorporate exercise into their daily routines. In Nigeria, for example, MSH is introducing mobile phones for health workers to monitor diabetes care, and minimize the need for women to travel long distances to health facilities. To overcome challenges of husbands and male partners limiting access to care -- even after wives were identified with GDM -- community-based, house-to-house awareness raising can help increase use of health services by women with GDM.
  2. The second health systems entry point is the intersection of tuberculosis (TB) and diabetes. It’s well known that the risk of developing TB soars when someone has diabetes. With the increase in diabetes globally, the threat of a double epidemic-- reminiscent of the dual epidemic of tuberculosis and HIV -- is very real. MSH is currently integrating diabetes screening for TB patients in Ethiopia and in Afghanistan, as well as screening for TB among diabetic patients. In Ethiopia, for example, a TB patient wasn’t getting better, despite adhering to the treatment protocols. After a health worker screened him for diabetes, and he was put on diabetes care, his health improved radically.
  3. The third entry point for strengthening health systems is increasing access to and use of quality medicines and commodities for preventing, diagnosing, treating, and caring for patients with diabetes. Currently, about one in three of the world’s poorest countries have access to insulin and other essential diabetes medicines and technologies needed for treatment. By building institutional and individual capacity in pharmaceutical systems and identifying appropriate roles for staff who provide medicines or medication-related services at each level, countries can strengthen the practice of pharmaceutical care in resource-constrained settings, such as Ethiopia. (MSH, through USAID’s Systems for Improved Access to Pharmaceuticals and Services [SIAPS] Program, describes this systems strengthening approach in detail.) Also, in Kenya and other developing countries, for example, MSH is partnering with Novartis on a unique program to increase access to chronic disease medications, including for diabetes.

Simultaneously, we all can continue to increase awareness of diabetes prevention, treatment and care at all levels of the health system -- global, national, health facility, and community -- through advocacy and health worker training. Share the messages of WHO, IDF, and others. Support governments already piloting projects and addressing policy changes and making critical investments. In Nigeria, for example, MSH is using the evidence from the GDM pilot to advocate for universal access to diabetes testing for pregnant women. By sharing this information at meetings and conferences, we continue to advocate at national, state, facility, and community levels for policy and training necessary to achieve the screening integration at the primary health care level, in line with the Nigerian Government’s plan to strengthen primary health care delivery for women and children.

To address the rising global burden of diabetes, we must create and scale-up health systems solutions that tap into existing opportunities to bridge the gap between knowledge and action in public health. Together, we can support developing countries to stay super, lead sustainable systems solutions, and beat diabetes.