In the developing world, the soaring diabetes pandemic requires partnerships on many fronts, including awareness and education, accessibility of care, local champions, government support and sufficient economic resources.

Timely treatment - Diabetes centre of excellence - A sustainable solution - The World Diabetes Foundation - The sustainable diabetes care model

The diabetes centre at Muhimbili National Hospital was established partly with funds raised by Novo Nordisk employees.

Having analysed the conditions for diabetes care in a number of developing countries, Novo Nordisk has developed a model for sustainable diabetes care in the developing world, with partnership as the most crucial element. As a company committed to bringing better diabetes care to this part of the world, we are just one player in a complex scenario that demands the coordinated resources of so many others, including patient organisations, ministries of health, healthcare professionals and private foundations that can help provide some of the desperately needed resources.

The partnership only succeeds if each party is willing to listen and learn from the other. In Novo Nordisk’s case we take our cue on where to place our priorities from the needs expressed by the people in the country who work most closely with diabetes and who are in a position to influence diabetes care. We also consider it important for all partners to sign a contract that describes a concrete plan of action, with milestones and follow-up measures. This helps ensure that the seeds that are planted for better diabetes care in a developing country are able to flourish without long-term dependence on outside  resources.

This model is being put to practice in eight countries; Tanzania is one of them. In this impoverished sub-Saharan African country, the estimated 350,000 Tanzanians with diabetes receive little or no care, and there are many more who are not even aware they have diabetes. This is due to many factors, including lack of awareness and education, a shortage of trained healthcare professionals and healthcare facilities, and insufficient economic resources to treat everyone who needs care.

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This is a situation that Dr Kaushik Ramaiya, a diabetologist and general secretary of the Tanzania Diabetes Association, has lived with in his 20 years of working with diabetes. Too often, says Dr Ramaiya, people first learn they have diabetes when they come to the hospital with serious complications such as blindness or a foot ulcer.

With the help of partners, Dr Ramaiya and his colleagues in Tanzania are now trying to change the situation for the better. A network of diabetes clinics is being established nationwide. In Dar es Salaam these are funded by Novo Nordisk and in the districts by the World Diabetes Foundation.

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The Ministry of Health in Tanzania is providing doctors and nurses to staff the diabetes clinics at the national and regional hospitals, while Novo Nordisk is giving training and education to the healthcare professionals. A key element of the new healthcare infrastructure for diabetes treatment in Tanzania is the centre at Muhimbili National Hospital in Dar es Salaam. Opened in March 2003, the centre is staffed by three nurses and several diabetes specialists working in rotation. It will serve as a centre of excellence in Tanzania, eventually incorporating a medical laboratory, a foot clinic and a diabetes information centre that trains doctors, nurses and people with diabetes from around the country.

With the establishment of the regional diabetes clinics in 2004, the centre at Muhimbili National Hospital can serve as a national referral centre and focus on treating people with complications and newly diagnosed patients. Once all the clinics are in place, Dr Ramaiya estimates that some 100,000 people with diabetes in Tanzania will have access to better treatment. The cost of treatment in the clinics is made affordable for most people with diabetes, while the very poorest receive subsidised treatment through the Tanzania Diabetes Association.

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Novo Nordisk has a partnership agreement to help run the diabetes centre at Muhimbili National Hospital until the end of 2005. At that point, it is hoped that the Tanzanians will be able to run it themselves as a truly sustainable solution.

For Dr Ramaiya, that is a solution that now seems within grasp. “Thanks to these regional clinics and the doctors and nurses being trained to staff them, as the clinics are being set up people will now be able to get the medicine, treatment and continuous monitoring they need. They are more motivated to take better care of themselves. This will go a long way towards reducing complications. Now we face the major task of informing citizens about the need to prevent and treat diabetes. We have a long way to go, but we’re making progress.”

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Novo Nordisk established the World Diabetes Foundation (WDF) in 2001 with an endowment of DKK 500 million to be spent over a ten-year period. This initiative aims to address the need for additional funding, which is one of the WHO’s four priorities for improving access to healthcare. The WDF is dedicated to supporting prevention and treatment of diabetes in developing countries. It acts as a catalyst to build relations among stakeholders, such as governments, diabetes organisations, hospitals and authorities. In this way, the WDF aims to ensure continued existence of initiatives after the completion of projects it has funded. It is governed independently of Novo Nordisk by a five-member Board of Directors. See WDF’s annual review at worlddiabetesfoundation.org.

The WDF focuses on:

• awareness of diabetes
• prevention of diabetes and its complications
• education and training of patients and healthcare professionals
• improvement of access to essential medicines in diabetes
• enhancement of detection, treatment and monitoring of diabetes.

The sustainable diabetes care model in developing countries put into practice in Tanzania
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