Africa Diabetes Foot Care Initiative

Africa Diabetes Foot Care Initiative Workshop, 1 December 2012 Nairobi, Kenya Silver Bahendeka, President IDF AfricaRegion Bénédicte Pansier, Account Manager, IDF Yelena Vainilovich, Education & HealthSystemsManager, IDF

Outline • Background • Minimum Skills Framework • Statement of need • Initiative Vision & Framework • Phase I: • Objectives • Work plan • Selected countries • Training process • Organizationalcapacity • Key stakeholders • Timeline • Budget • Phase II: objectives

Diabetes: new priority for Africa • African Declaration in Cape Town (2006) • Landmark UN Resolution 61/225 on diabetes (Dec 06) • UN Summit on NCDs (Sept. 2011) • “25% by 2025” target adopted at UN World Health Assembly (May 2012) • First Africa Diabetes Congress in Arusha (July 2012) • UN Global Monitoring Framework (Nov 2012) * source: 2012 IDF Diabetes Atlas Update

IDF Diabetes Atlas 2012 Update

The burden of diabetes in Africa • Diabetes*: growing epidemic in Africa 14 million people with diabetes (to double in 20 yrs) • World’s highest rate of undiagnosed diabetes (81%) • World’s highest mortality rate • Severe complications: microvascular complications, foot ulcers, macrovascular complications * source: 2012 IDF Diabetes Atlas Update

Africa Diabetes Foot Care Initiative

Minimum Skills Framework components • Identification of patient risk status • Provision of basic foot care advice • Hotline access for new disease-integrated into a referral system • Assessment of those at risk, by a health worker trained in diabetes foot care • Assessment and management of new disease by a health worker trained in diabetes footcare • Management of the person whose disease has recovered

Minimum Skills Framework for the Africa Foot Care Initiative • A primary-care vs. specialty-care-based approach incorporating community engagement • Use of diabetes care champions that involve community leaders, especially in health care messages • An explicit team approach that involves the community using pre-defined community engagement strategies • Inclusion of psychosocial assessment and behavioural strategies • On-going staff training • Comprehensive information technology that will include electronic medical records and education

Statement of Need • Need for an interdisciplinary approach, with a well-structured organization and appropriate facilities • Need for concerted action by all people working with people with diabetes • Need for specific uniform and consistent high standard guidelines • to reduce the risk of development and progression of diabetic foot disorders • to realize a uniform high standard of diabetic foot care

Vision Main goal: lower extremity amputation prevention Secondary objectives: • Decrease practice variation • Increase patient satisfaction • Increase clinician satisfaction • Provide evidence-based care to people with diabetes • Reduce costs of care (achieved by 10% reduction in costs of outside referrals and hospital utilization) • Improve clinic foot examination rates • Improve quality of life of people with diabetes

Initiative Framework

2-phase Initiative • Phase I (Oct 12-Sept 13): Establishing the Initiative • Phase II (Oct 13-Sept 16): Evaluating and building capacity for excellence

Phase I: Objectives • Develop an evidence-based Risk Stratification and Intervention Tool and its associated protocol • Develop a Foot Assessment and Intervention Curriculum for the African Region • Select and train health workers from 10 selected sites • Establish & strengthen the capacity of 10 selected sites • Start information activities with IDF member associations • LiaisewithHealthauthorities to establisha foundation for a community/ national engagement

Phase I: Work plan

10 selected sites: criteria • French or English speaking • Associated with IDF’s National Member Association • Established diabetes clinic • Supported by the Ministry of Health • Willing to partner with Sanofi • NOT a foot specialty centre • Highly motivated • Stability of staffing • Presence of a local diabetes care foot programme champion • Ability to engage the local community in the diabetes care programme

10 selected sites

The training process PHASE I: Initial training of 10 ‘training teams’ (Jan-June 2013) - confirmed Step 1 Internal training through e-diabetes (UNFM / IDF experts) 2/3 HCPs identified to attend 1st training (1 doctor&1/2 nurses/ country) Step 2 One-week training in Jo’Burg by UJ&USenghor Foot Care Diabetes Assistants 10 ‘Training teams’ trained PHASE II: Roll-out in 10 African countries (July 2013 and beyond) – pending Sanofi’s grant renewal 10 Satellite training centers’ accredited Step 4 5-day training of HCPs in training centers by training team&moderator from UJ or USenghor Step 3 Accreditation & quality control by UJ& USenghor Training accredited, report completed & HCPs trained

Organizational Capacity 1. Africa Diabetes Foot Care Technical Committee (Gate Keeper of the Project) • Chair: Dr. Silver Bahendeka, IDF Africa Region • Vice Chair: Dr.EvaristeBouenizabela, IDF Africa Region • The Secretary & Africa Diabetes Foot Care Coordinator • Dr.KaushikRamaiya, IDF Africa Region • Representative from IDF Global office, Policy and Programmes department • Dr. Line Kleinebreil, UNFM e-education • Dr Z Abbas, International Working Group on Diabetes Foot, Expert Advisor • Prof George Ramahandridona, Expert Advisor • Prof. Andrew Boulton, Expert Advisor • Ms Fatima Cassim, University of Johannesburg • Dr. Christian Mesenge, Université Senghor, Alexandria 2. Diabetes Foot Care Coordinator: MaïmounaMbaye

Key stakeholders 10 selected sites IDF Member Associations MoH and healthauthorities

Budget (in EUR)

Timeline

Phase II: Objectives • Integrate knowledge and skills into clinical practice • Monitor and evaluate use of risk stratification tool and protocol by selected participants • Validate risk scoring tool • Build capacity and develop ‘Model Diabetes Centres’ • Strengthen and consolidate the community engagement

Thank you The global advocate for people with diabeteswww.idf.org

Africa Diabetes Foot Care Initiative