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VOLUME 7 NUMBER 4 • NOVEMBER 2010
AFRICAN FOCUS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
The social determinants of health include the environment in which
people live and work, while cultural and societal values also play a
role in some NCDs, for example, obesity. Social scientists are adept
at determining the ‘causes of causes of NCDs’. They also have
an important role to play in the implementation of health policy,
a serious challenge to the management of NCDs in most sub-
Saharan African countries. ‘Social scientists can assist healthcare
workers and policy makers in strengthening communication and
sensitising communities’, said Dr Amuyunzu-Nyamongo. She also
made a plea for a multidisciplinary research agenda that includes
social anthropologists.
The formation of NCD alliances between stakeholders is critical
in lobbying for the NCD cause, according to
Ms Susanne Volqartz,
director of development, theDanishNCDAlliance
. NGOs have a
traditionofworking against eachother in fund raising andpromoting
individual causes. By forming the Danish NCD alliance between the
International Diabetes Federation, the World Heart Federation,
the Union for International Cancer Control and the International
Union Against Tuberculosis and Lung Disease, it was possible to
form a massive lobbying group representing more than 600 000
people in Denmark with its small population of 5.5 million people.
‘Disease prevention has no constituency’, said Ms Volqartz,
therefore disease prevention receives very little attention, while
governments are forced to act when people are already sick. She
also pointed out that many NCDs share the same social causes such
as tobacco use, unhealthy diet, lack of physical activity and the
harmful use of alcohol. It therefore makes sense for NGOs focusing
on individual diseases or groups of diseases to form an alliance
to convey powerful messages to the community and to persuade
government to invest in disease-prevention strategies. Lobbying
strategies must be supported by quality data, to be successful.
The session ‘National diabetes/NCD programmes’ was somewhat
disappointing with regard to the negative messages that came
across during the panel discussion.
Dr Emmanuel Nomo from
the Cameroon Ministry of Health
informed the meeting that
the CVD risk-factor profile of people in the Cameroon is very similar
to that of the South African black population. Although excellent
plans were made on how to deal with NCDs between 2004 and
2006, little technical support and financing was forthcoming to
implement these policies, a common phenomenon in sub-Saharan
African countries.
‘Mozambique has already formulated a national framework
to deal with NCDs and is now looking at ways to incorporate
the management of NCDs into primary healthcare and level-two
services’, according to
Dr Carla Matos from the Ministry of
Health
in that country. Dr James Sekajugo, Uganda Ministry of
Health, explained the relatively complex healthcare system in place
in that country. ‘The Department of Health only informs and it is
expected of individuals to take care of their own health’, said Dr
Sekajugo. Another interesting aspect of healthcare management
in Uganda is the inter-sectorial co-operation between the state
departments of Health and Finance. Other sub-Saharan African
countries are plagued by lack of basic data on NCDs, lack of
funding for essential medication such as insulin, and inadequate
infrastructure. It was heartening to learn, however, that these
deficiencies are recognised and confronted.
At the end of this session a delegate from the floor remarked that
‘the voices from the panel are very passive. Will we ever manage (to
deal with the burden of NCDs) if our policy makers are lukewarm?’
The session ‘Transitioning from concept to implementation’ was
introduced by
Dr Anil Kapur, managing director, International
Diabetes Federation
. The WDF is currently funding 236 projects
in 93 countries and Africa is receiving more than its fair share of
this funding: 90 projects (69 ongoing) were funded in 34 African
countries. This initiative has since its inception placed 4 700 doctors
and 7 125 nurses in Africa; 990 diabetes clinics were established on
the continent, some of these are ‘container clinics’ and these clinics
could form a nidus for NCD clinics. The focus areas for these projects
include the diabetic foot, screening for eye disease, mothers and
children with diabetes, and the co-occurrence of diabetes and TB.
Dr Eva Njenga
reported on the success of a WDF diabetes
project in Kenya. Successful partnerships were formed between
the Ministry of Health and diabetes organisations, resulting in the
provision of 3 900 healthcare workers and 400 lay community
workers, the opening of 45 diabetes clinics and the strengthening
of 109 additional healthcare facilities over a 10-year period. A great
premium is placed on public awareness, diabetes education and
involvement of the youth.
Dr Abbas from Tanzania
discussed the ‘step-by step’ WDF foot-
care project in that country. In this programme, emphasis is placed
on creating awareness and the provision of educational material
and foot-care starter packs. Data are continuously collected from
15 foot-care centres in 14 regions. The main aim of this initiative is
to reduce the amputation rate in Tanzania.
Dr Nelia Steyn from the MRC, South Africa
, discussed a WDF
funded interventional project ‘Health Kick’ aimed at developing
healthy lifestyle programmes in schools, mainly by promoting
healthy eating habits. In the
Cameroon, Dr Eugene Sobngwe
initiated a WDF-funded study to establish the most cost-effective
and practical method to diagnose gestational diabetes, while
Prof
Bob Mash from the Western Cape
discussed the successful
WDF-funded project on the improvement of the quality of diabetes
care at primary healthcare level in that province.
Dr Silver Bahendeka
introduced the session ‘The Africa
Diabetes Care Initiative (ADCI) 2010–2012’. He highlighted the fact
that diabetes mellitus is a major health threat in the developing
world. It is confounded by the double burden of disease. Many
African countries do not have national diabetes care programmes.
There is also a widespread lack of essential medicines. He made the
comment that ‘Talk does not cook rice – it is time to act’. Barriers to
achieve optimal diabetes care have to be identified and addressed.
Africa needs a programme that will maximise key resources,
support self-management and push forward viable and sustained
management programmes. This need led to the development of the
African Diabetes Care Initiative by the IDF. The ADCI will focus on
three main areas: education, diabetes in children and the diabetic
foot. A task force was established for each of these focus areas.
‘Africa is a continent of great contrasts, immense potential and
great challenges’, said
Ms Grace J’Alango from Kenya
. There are
more than 12 million people in Africa with diabetes. Prevention is
paramount to stop the rapid increase. The answer lies in diabetes
education. The ADCI plans to roll out diabetes conversation maps
in all sub-Saharan African countries. There are several barriers in the
field of diabetes education, including the lack of career pathways
and a lack of resources.
Dr Ali Mohamed Gaman from Kenya
, a diabetologist and
An increase in life expectancy of one year can lead to a 4%
increase in GNP –
Prof Ayesha Motala
