In the fight against chronic diseases, such as diabetes, the World Health Organization (WHO) is calling for national strategies: activities to improve the prevention, care and control of the disease. Novo Nordisk’s response is the National Diabetes Programme. Its aim is to promote collaboration between all parties in healthcare in order to improve the care and quality of life of people with diabetes.

Matching national needs - Improved care in the developing world - Training doctors and nurses - Declaration of Africa on Diabetes

A diabetes team at M.S. Ramaiah Hospital in Bangalore, India, discuss treatment follow-up with a woman with diabetes.

Assisting in the development of national diabetes programmes is one of the main building blocks in Novo Nordisk’s efforts to get diabetes on the public health agenda and drive earlier diagnosis and earlier treatment, creating a better quality of life for people with diabetes. We think this approach can make a real difference to their health and well-being. And because it is about building long-term relationships with key stakeholders and about offering solutions, not just products, it also offers Novo Nordisk the opportunity to build a long-term sustainable business advantage as a leader in diabetes care.

Novo Nordisk launched its National Diabetes Programme (NDP) in 2000 as a systematic approach to improving diabetes care throughout the world. Most of our 69 affiliates have participated in workshops that give them the tools to work closely with partners in this integrated approach to diabetes.

We have developed the book National Diabetes Programmes Toolbox to give practical guidance to affiliates and their partners. At international level, Novo Nordisk works closely with the International Diabetes Federation (IDF) on its national diabetes programme and in the development and sponsorship of specific tools such as the Diabetes Atlas and the Guide for Diabetes Guidelines.

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In Russia, in partnership with the Ministry of Health and key opinion leaders, Novo Nordisk sponsors a mobile scientific and research diabetes centre. It brings leading diabetes specialists to various regions of Russia to monitor how widespread diabetes and its late-stage complications are in the country. Each expedition takes four weeks and is preceded by an introduction for local healthcare professionals. When the project is completed in 2005, more than 10,000 people will have passed through its doors and received thorough examination. Moreover, the body of data – including metabolic control and late-stage complications – from those people is leading to a national patient register.

At national level, Novo Nordisk affiliates around the world are putting the tools of the NDP into action. More than 130 activities have been combined into a best practice database for inspiration and learning. In the developed world, the NDP is focused on developing strategies to enhance diabetes care. This includes raising awareness among people with diabetes and the general public, educating healthcare professionals, highlighting the economic burden of diabetes, establishing clinical care guidelines and improving early diagnosis of type 2 diabetes.

At Novo Nordisk in the US, part of the NDP focus is on raising awareness among minority populations for whom diabetes is a particularly serious health risk compared to the US population as a whole. In 2003 Novo Nordisk sponsored a 20-minute TV programme about diabetes aimed at the Hispanic population and shown during Diabetes Month in four major American cities with large Hispanic populations. The programme was endorsed by the American Academy of Clinical Endocrinologists (AACE) and was accompanied by a booklet on diabetes distributed to AACE members at their annual meeting. It won an Emmy for Outstanding Achievement for Informational Programming for the Chicago/Midwest region. In 2004 Novo Nordisk and the American College of Physicians are teaming up to do a similar programme for African Americans to be broadcast during National Black History Month in February.

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While the developed countries often have a foundation on which to build better diabetes care, that is not always the case in the developing world. That is why Novo Nordisk has paid special attention to developing a model for improving the treatment of diabetes in the poorest countries. The NDP initiatives in these countries are illustrated in our case study on Tanzania.

Under the NDP, Novo Nordisk is focused on bringing about improved diabetes care in eight developing countries: China, India, Bangladesh, Costa Rica, El Salvador, Malaysia, Tanzania and Zambia. Each of these programmes is built on partnerships, where Novo Nordisk bases its priorities for action on the needs expressed by local experts and where all efforts should be sustainable – that is, the country can continue the activity independently in the long term. In order to ensure this kind of approach, contracts are signed in each country indicating the expected milestones and follow-up actions.

In China, the local affiliate is working with local associations of healthcare professionals, the Ministry of Health and the World Diabetes Foundation, an independent foundation set up by Novo Nordisk in 2001 to improve diabetes care in the poorest countries, to implement an ambitious diabetes action plan. This includes establishing 31 centres of excellence covering 311 cities, each with a population of half a million or more, over the next five years.

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In India, the Novo Nordisk Education Foundation is working closely with the Indian Council of Medical Research and the WHO Collaborating Centre in Chennai to formulate a National Diabetes Control Programme (NDCP). The NDCP aims to focus the attention of policy-makers and other stakeholders on problems related to diabetes in India, and serves as a framework for state governments in establishing diabetes clinics and prevention centres. In parallel with the ongoing work on the NDCP, several workshops aimed at raising awareness among all stakeholders will be organised over the next two years.

Education of healthcare professionals, particularly about diabetes foot complications, is the focus of the NDP programme in Malaysia. In Costa Rica, the level of healthcare is higher compared to much of the rest of the developing world, in that people with diabetes receive insulin free of charge. However, many do not take insulin on a daily basis due to lack of education and awareness about the need for daily treatment for this chronic disease. Therefore, in Costa Rica, efforts are focused on improving awareness and education of people with diabetes.

In El Salvador, the approach is to help strengthen the national patient organisation as well as upgrading the diabetes centre in the capital and trying to engage with the government to implement a national diabetes strategy. In Bangladesh, the focus is on establishing a diabetes foot clinic at a leading hospital, and educating and training physicians through a distance-learning programme in collaboration with experts from the UK.

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In May 2003, representatives of 15 countries, the WHO, the IDF and Novo Nordisk met in Zanzibar, Tanzania, to discuss how to increase awareness of diabetes among African health policymakers. The result was the draft Declaration of Africa on Diabetes, a document that includes an analysis of the diabetes situation, a commitment to addressing the problem and an action plan.

Similar declarations, such as the Western Pacific Declaration on Diabetes and the Declaration of the Americas on Diabetes, have shown that such initiatives typically increase awareness of diabetes and lead governments and other major stakeholders to take major steps to address the diabetes pandemic.

In Zambia, for example, we are striving to improve diabetes care by working with the Ministry of Health to develop a national diabetes programme and providing funding and staff resources for workshops. We are also supporting the national diabetes association in establishing a diabetes clinic at the national hospital. This clinic will serve as the primary information centre for people with diabetes as well as a centre for training healthcare professionals and diabetes educators.

Through the NDP, Novo Nordisk seeks to assist key diabetes stakeholders in building a sustainable infrastructure, boosting standards of diabetes care, and ultimately improving the quality of life for people with diabetes. If we succeed, we will be one step closer to realising our vision.