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Africa Diabetes Foot Care InitiativeWorkshop, 1 December 2012
Nairobi, Kenya
Silver Bahendeka, President IDF Africa RegionBénédicte Pansier, Account Manager, IDF
Yelena Vainilovich, Education & Health Systems Manager, IDF
Outline• Background• Minimum Skills Framework• Statement of need• Initiative Vision & Framework• Phase I:
– Objectives– Work plan– Selected countries– Training process– Organizational capacity– 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
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
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 foot care • 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
Þ to reduce the risk of development and progression of diabetic foot disorders
Þ to realize a uniform high standard of diabetic foot care
VisionMain 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
Patient Education and early foot intervention
Certified HWFaculty Curriculum
Selected HW
Clinical experience
Prepared clinical environment
Risk stratification
and intervention
tool
Risk score toolRelated Protocol
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 Liaise with Health authorities to establish a foundation
for a community/ national engagement
Phase I: Work planOutcome 1: Develop tools and guidelines on Foot Care that are culturally appropriate and locally relevant
Output1.1 Develop a foot assessment and an intervention curriculum
Output1.2 Develop a risk stratification and intervention tool and its associated protocol to prevent complications of the foot
Outcome 2: Develop adequate organizational capacity to deliver quality interventions on Foot Care
Output2.1Health workers in the selected centres are trained on the use of the risk stratification and intervention tool in their clinical practice and have received a certificate of completion of the training
Output2.2Member Associations in the selected countries have established a working relationship with the relevant government health authorities and communities
Output2.3Proper working conditions are established in the regions and in the selected sites to deliver the interventions
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
The training process
Step 1Internal training
through e-diabetes (UNFM / IDF experts)
2/3 HCPs identified to
attend 1st training(1 doctor&1/2
nurses/ country)
Step 2One-week training in
Jo’Burg by UJ&USenghor
Foot Care Diabetes Assistants
10 ‘Training teams’ trained
Step 3Accreditation
& quality controlby UJ&
USenghor
PHASE II: Roll-out in 10 African countries (July 2013 and beyond) – pending Sanofi’s grant renewal
10 Satellite training centers’
accredited
Step 45-day training
of HCPs in training
centersby training
team&moderator from UJ or USenghor
Training accredited, report completed & HCPs trained
PHASE I: Initial training of 10 ‘training teams’ (Jan-June 2013) - confirmed
Organizational Capacity 1. Africa Diabetes Foot Care Technical Committee (Gate Keeper of the Project)
– Chair: Dr. Silver Bahendeka, IDF Africa Region – Vice Chair: Dr.Evariste Bouenizabela, IDF Africa Region – The Secretary & Africa Diabetes Foot Care Coordinator – Dr.Kaushik Ramaiya, 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: Maïmouna Mbaye
Budget (in EUR)Risk stratification and intervention tool
1st Workshop of the Technical Committee 12,000
2nd Workshop of the Technical Committee 12,000
Training of health care professionals
e-diabetes program - Recording and courses 8,000
Communication and invitations 2,000
Face to face training in Johannesburg 91,000
Engagement of 10 Centres in the selected countries
Kick-off meeting in Nairobi 20,000
Engagement of Communities
Production of education materials 6,400
Operational Costs
Project Coordinator, travels, miscellaneous 56,000
IDF support and expertise 50,000
Contingency 2,600
TOTAL BUDGET (EUR) 260,000
TimelineActivities
2012 2013
Oct Nov Dec Jan Feb Mar Apr May Jun July Aug SepActivity 1.1.1 Establish agreement Activity 1.1.2 Develop curriculum (by the Universities)
Activity 1.1.3
Peer review and revise - approval of Technical Committee
Activity 1.1.4 Select Faculty (by the Universities)
Activity 1.2.1 Literature & Best Practice Review
Activity 1.2.2
Meeting of the technical committee review of evidence (Telcon)
Activity 1.2.3
Workshop of the technical committee - 1 day (EASD)
Activity 1.2.4
Technical committee should meet again in the second semester (date to be confirmed) to review progress made
TimelineActivities
2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Activity 2.1.1 e-diabetes preparation
Activity 2.1.2 Select participating health workers
Activity 2.1.3 e-diabetes program - Recording and courses
Activity 2.1.4
Communication & invitation - Invitations by IDF with recognition of Sanofi's involvement
Activity 2.1.5
Assess learning needs - 1st session to be dedicated to evaluate the level of knowledge and expectations
Activity 2.1.6
Evaluate and select candidates for F2F training (1 doctor&1-2 nurses/country)
Activity 2.1.7 Face to Face education and skills training
Activity 2.1.8
Accreditation of the 10 selected centers by Jo'Burg University and University Senghor
TimelineActivities
2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Activity 2.2.1
Face to face meeting with MoH in some countries
Activity 2.2.2
Co-joint letter to centers, MoH and patient associations
Activity 2.2.3
Face to face meeting in centers to present program
Activity 2.2.4
Analysis and audit of the selected Centers (equipment)
Activity 2.2.5
Selection of the project leader in the center and a project manager
Activity 2.2.6
Selection of diabetes associations - program presentation
Activity 2.2.7
Analysis and audit of existing activities/structure
Activity 2.2.8
Official meeting to start the program in Nairobi on 1-2 December 2012
Activity 2.2.9
Regular communication with centers
TimelineActivities
2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Activity 2.3.1
Desktop research - foot care in Africa Region
Activity 2.3.2
Foot complications - record review and prospective data collection -
Activity 2.3.3
Background assessment of clinical environment
Activity 2.3.4
Meeting of the technical committee review of evidence (Telcons)
Activity 2.3.5
Meeting of the technical committee review of evidence (Telcon) - end of the program
Activity 2.3.6
Selection and adaptation of existing material
Activity 2.3.7
Support to develop activities - Equipment, space and material
Activity 2.3.8
Production of education material - e.g. Foot care kit for patients (Indian production)
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
Jan Feb Mar Apr May Jun July Aug Sept
Letter to Centrers, MoH & MA
Follow-up meeting with mgnt / MoH + engagement letter
Initial Audit of Centers
RiskStratTool & protocol implemented
Inform/liaise with stakeholders
Information with IDF MA
E-diabetes (1/week?)
Selection of HW / quizz
Mid-term Report
Foot Kit ordered
Manual sent to selected HW
F2F training in JoBurg
Follow-up/ practice in Centers
Accreditation of Centers
2° Audit of Centers
Final Report
End of Phase I