Department of Diabetes and Endocrinology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar
Diabetes is one of the four non-communicable diseases responsible for highest mortality and morbidity across the world. It is covered in the essential services packaged to be provided at primary health care facilities (PHC) in Khyber Pakhtunkhwa (KP). However, an effective system to prevent and facilitate the treatment of the disease at this level is not operational. As a result, in a majority of cases, people get to know they are sering from disease when they start seeing early signs of complications.
The pilot has established a system to Identify pre-diabetic/diabetic patients at an early stage to save them from complications. A manual has been developed in consultation with experts, doctors and paramedic staff trained, and a registration and referral system operationalized for this purpose. The model also includes behavior change interventions to promote awareness of the disease.
The D-TALK pilot targeted about 34,000 beneficiaries including some 52% women and about 85.7% rural populations in the 6 districts.
- The pilot developed a long awaited manual/toolkit for doctors and paramedics for screening people for diabetes in healthcare facilities. The first of its kind this manual was developed in consultation with leading national experts from across the country. The use of this manual will not only be restricted to KP and will be used in the entire country.
- 62 doctors and 75 paramedic staff were trained on this manual in six pilot districts who are using the new approaches and practices to attack the menace of diabetes in six SNG districts.
- Registration and referral system for pre-diabetic and diabetic patients has been established in 62 health facilities.
- Authentic data on prevalence of disease is being gathered and analysed to inform policy and strategy to fight diabetes. The project has found that 40% of people screened under the project were suffering from diabetes—a majority being women. Thus, the project has generated credible evidence that prevalence rate of the disease is much higher than what is currently reported, thereby influencing policy discussion at provincial government level.
Adoption and Scale-up:
Average cost of implementing the model in one district is estimated at 25 million per year. At this rate, it will cost approximately PKR 700 million to adopt this model across the province. This needs to be done preferably in three phases to ensure that the new practices are properly embedded in health care apparatus. The cost for each phase will be around PKR 225 million. The project shall help in early detection and treatment of disease in 8,000-9000 patients (average cost PKR 3000/patient) per district. Aside from this core group of beneficiaries, the project shall ensure that all patients who visit PHC facilities are screened for the disease. This will benefit millions of peoples. The project has been scaled up for the entire province.