VOLUME 7 NUMBER 4 • NOVEMBER 2010
157
SA JOURNAL OF DIABETES & VASCULAR DISEASE
AFRICAN FOCUS
need to interact with the health system regularly for life, need to
take responsibility for their health and self-care, sustain healthy
behaviour and access psychosocial support. Like those with HIV, they
too require diagnosis, and enrolment and retention in treatment
programmes, multidisciplinary care, longitudinal monitoring, and
linkages and referrals.
Aspects to consider include civil society engagement, patient
advocacy and a change of mindset fromone of hopelessness to belief
that treatment is viable. As with HIV/AIDS, simplified standardised
diagnosis and management protocols are required, along with
standardised first- and second-line drug regimens. Treatment
needs to be decentralised to district level, task shifting from
doctors to nurses needs to take place, the procurement and supply
chain needs to be strengthened and there must be transparency
in respect of record keeping, data use and target setting.
‘Few, if any continuity care systems currently exist for diseases
other than HIV/AIDS in resource-poor settings, however’, said Dr
Rabkin. She offered the following three suggestions:
• Use a public health approach, entailing simple, standardised
protocols as well as a minimum treatment package.
• Adapt systems and tools that already exist for HIV/AIDS with
a view to ensuring,
inter alia
, point-of-service diagnostics and
co-location of services.
• Screen and treat. ‘Think “systems” to enable a more holistic
approach’, she concluded.
Leveraging HIV services to address NCDs is indeed a viable
option.
Dr Frank Mwangemi, deputy director of Family
Health International (FHI) in Kenya
, gave an overview of a
successful pilot project to integrate HIV and cardiovascular disease
(CVD) services in that country. It was undertaken to monitor the
cardiovascular complications of patients on HAART.
‘Knowing that as time goes by, patients on ARVs experience
increased CVD risk, we built the capacity of existing staff to deliver
CVD prevention and care services in addition to those for HIV. We
adapted our existing health information systems/tools and enhanced
our laboratory capacity to incorporate CVD. The acceptability
of this integration to both staff and patients was very high.’
He underscored the importance of partnerships, noting that
while FHI had provided the seed funding for the project, the Kenya
Cardiac Society had provided training and support and USAID had
provided the funding for HIV services. ‘Government buy-in was also
essential’, he said.
‘HIV and CVD integration is indeed feasible in low- and middle-
income countries’, he concluded. ‘The integration helped us to
identifypreviouslyundetectedriskfactorssothatwecouldimplement
prevention and management strategies. Routine blood pressure
monitoring, particularly, given the risk of hypertension associated
with ARVs, needs to be part of AIDS care and treatment. Prevention
is cheaper and better than cure and I call on all policy makers to take
into account the medical and socio-economic benefits thereof.’
In a similar vein,
Dr Knut Lonnroth, medical officer in the
Stop TB Department of the World Health Organisation
,
posited a collaborative framework for the care and control of TB
and diabetes. He described them as colliding epidemics, with each
increasing the risk of the other. ‘It’s therefore important not to have
colliding treatment programmes’, he said.
The framework has yet to be piloted, but it aims to screen for
diabetes in TB patients, and where there is a high background
prevalence of TB, to screen diabetics for the disease. The DOTS
model of TB treatment, which has been used with great success
since 1995, will be adapted to diabetes. ‘TB programmes can
help to advocate broad diabetes prevention and care efforts’, he
concluded, ‘and can also contribute to broader healthcare system
strengthening.
Innovations in healthcare delivery: the use of mobile
messaging
One billion people in Africa are underserved by conventional
infrastructure, something that is a key barrier to healthcare
provision. However, 45% have access to mobile phones and this
is growing rapidly.
Gustav Praekelt, founder of the Praekelt
Foundation
, gave an overview of two case studies, not specifically
about diabetes, that spotlighted the success of an SMS programme
called ‘TxtAlert’ in communicating with patients who would
otherwise have been difficult to reach.
‘SMS is a universal technology and its use to send patients
reminders about their appointments and also to allow them to
reschedule, mades a significant impact on an HIV/AIDS adherence
programme at Helen Joseph Hospital’, he said. It reduced the
percentage of patients lost to follow up significantly.
The second study looked at the impact of a free mobile portal
called ‘Young Africa Live’, which aimed to engage young people pre-
diagnosis in interactive conversations around sex and gender issues.
Topics included dating tips, circumcision, what makes you gay, and
multiple concurrent sexual partnerships. Topics have drawn as many
as 452 000 comments, and 76 000 daily views have been logged.
‘There is some very interesting work being done around mobile
technology, which allows for large-scale patient engagement’, he
concluded.
The theme of the second day of the Diabetes Leadership Forum
was ‘Facing the futurewith hope for all ages’.
Dr Silver Bahendeka,
chair, IDF African region
, introduced this session by stating that
the time of ‘testing urine with the tongue’ is long gone. It was,
however, a long walk to free people in Africa from the shackles
of diabetes. New technology-based models of care are called for
in Africa to manage diabetes and other NCDs without reinventing
the wheel. In spite of the encompassing theme, NCDs in the
elderly unfortunately did not receive any attention at this meeting.
Most countries in sub-Saharan Africa have introduced national
NCD programmes and developed guidelines since 2001, said
Dr Kaushik Ramaiya from Tanzania
. This was followed by an
increase of up to 50% in government funding in some countries
over the following eight years. The key strategy used by healthcare
workers to achieve this included advocacy, setting of priorities,
mobilisation of resources and empowering people. Unfortunately,
there are still some countries in sub-Saharan Africa where basic
drugs are still unavailable. Scarce funding is still consumed by
‘catastrophic spending’ on the end result of NCDs, such as stroke
and myocardial infarction. Dr Kaushik made a plea for the step-
wise implementation of NCD programmes as well as to expand the
list of traditional NCDs to include epilepsy and sickle cell disease
among other chronic conditions.
‘Medical doctors may not be great communicators but their
opinions are respected when talking to politicians’, said
Dr Mary
Amuyunzu-Nyamongo, a social scientist and executive
director of the African Institute for Health and Development
.
Social scientists, however, have an important role to play in health
promotion as a vehicle to bring communities on board as partners
and to assist people to take control to improve their own health.
