LETTER
SA JOURNAL OF DIABETES & VASCULAR DISEASE
28
VOLUME 7 NUMBER 1 • MARCH 2010
Are we doing enough to save diabetes services in
South Africa?
As clinicians in South Africa, we seem to be disconnected
from the planning of public health services and my question,
directed at my colleagues, is whether we can contribute more.
There is a recognition that public sector diabetes services
are sub-optimal and unequal in distribution in South Africa.
Budget constraints and limitations on staff have forced the
medical fraternity to consider different ways of working
together to improve efficiency, so that quality of care is more
evenly distributed and practice is of a higher standard.
Some of the solutions may be to: (1) move staff to where
the bulk of the patients are, (2) get specialised staff such
as podiatrists to train staff from all the facilities to do basic
screening, and refer high-risk cases to higher-level hospitals,
(3) have greater involvement of family medicine specialists, (4)
re-look at referral patterns and protocols, (5) develop a spirit
of sharing of resources between institutions, (6) set up an
advisory panel for assessment of all levels of health facilities.
Endocrinologists can assist the Department of Health in
the following ways:
Set up a local diabetes advisory panel, consisting of
•
endocrinologists and family medicine specialists,
as well as ophthalmologists, podiatrists, dieticians,
pharmacists and diabetes nurse educators.
This panel could visit local hospitals and clinics and
•
do on-site assessments, draw up recommendations
for improving the diabetes service with the resources
available at those sites, and suggest additional critical
resources, if indicated. They should look at office
space, equipment, staff and operating procedures.
The panel could review protocols and develop training
•
programmes for staff and patients. Non-governmental
organisations (NGOs) would also be engaged, for
example the Diabetes Education Society of South
Africa (DESSA).
This panel may convene a monthly meeting, with
•
representatives from local hospitals and clinics, to
monitor progress. Interested parties at each institution
would be identified to drive the development process
at each site.
Sample assessment:
One would need to identify space at Hospital X for six
•
to eight consulting rooms, including a nurses’ station,
treatment room, podiatrist room, diabetes nurse
educator’s room, training/lecture area, and waiting
area.
Staged appointments could be used to spread the
•
load over the whole day.
Staff needed for the clinic (one day only): one
•
endocrinologist/physician, one medical officer, one
registrar, two medical officers with family medicine
backgrounds, one podiatrist and one diabetes nurse
educator, two clinic sisters, two staff nurses, one clerk,
and enough doctors for about 90 patients.
A staff training session would be needed for one hour
•
after each clinic.
Extra capacity would be needed in the hospital’s
•
pharmacy for clinic day staff and medication stock, as
well as providing glucose testers and test strips.
The role of a podiatrist and nurse educator would
•
be to train local staff to counsel patients, do basic
assessments and identify high-risk patients for onward
referral to the podiatrist and nurse educator/doctor.
Hospital X’s clinic would refer patients to dietician/
•
ophthalmology/renal/ neurology clinics as required.
Proper records and a database would have to be
•
maintained and audited.
Protocols for referral up and down must be reviewed
•
periodically.
A six-month phasing-in period should be aimed for.
•
Family medicine could organise bi-annual diabetes
•
education programmes for staff at all the facilities and
assist in planning and running the diabetes service.
Alternative models:
All newly diagnosed diabetic patients could be referred
•
to a tertiary hospital for a one-month initiation phase
of intensive training and fine-tuning therapy. A full
report would be drawn up for the patients’ care and the
follow-ups would be done at the primary/secondary-
care level. Assessment of facilities, as above, should
still occur as well as outreach education programmes.
Set up single metropolitan diabetes centres as distinct
•
entities and close all diabetes services at local hospitals.
This is an impractical option, but can be debated.
Conclusion
Unfortunately, to provide a better service, some money has to
be spent. We have to look at different ways of doing things. I
am hoping to start a debate on our involvement in improving
services in South Africa. We must make an effort to improve
diabetes care in South Africa.
Corrrespondence to: Dr F Mahomed
Principal endocrinologist, Department of Internal Medicine, Grey’s Hospital,
Pietermaritzburg
Tel: +27 (0) 33 897-3213
Fax: 086 6474 729
e-mail:
S Afr J Diabetes Vasc Dis
2010;
7
: 28
