Africa Diabetes Foot Care InitiativeWorkshop, 1 December 2012

Nairobi, Kenya

Silver Bahendeka, President IDF Africa RegionBénédicte Pansier, Account Manager, IDF

Yelena Vainilovich, Education & Health Systems Manager, IDF

Outline• Background• Minimum Skills Framework• Statement of need• Initiative Vision & Framework• Phase I:

– Objectives– Work plan– Selected countries– Training process– Organizational capacity– Key stakeholders– Timeline– Budget

• Phase II: objectives

Diabetes: new priority for Africa• African Declaration in Cape Town (2006)

• Landmark UN Resolution 61/225 on diabetes (Dec 06)

• UN Summit on NCDs (Sept. 2011)

• “25% by 2025” target adopted at UN World Health Assembly (May 2012)

• First Africa Diabetes Congress in Arusha (July 2012)

• UN Global Monitoring Framework (Nov 2012)

* source: 2012 IDF Diabetes Atlas Update

IDF Diabetes Atlas 2012 Update

The burden of diabetes in Africa

• Diabetes*: growing epidemic in Africa 14 million people with diabetes (to double in 20 yrs)

• World’s highest rate of undiagnosed diabetes (81%)

• World’s highest mortality rate

• Severe complications: microvascular complications, foot ulcers, macrovascular complications

* source: 2012 IDF Diabetes Atlas Update

Africa Diabetes Foot Care Initiative

Minimum Skills Framework components

• Identification of patient risk status • Provision of basic foot care advice • Hotline access for new disease-integrated into a referral

system • Assessment of those at risk, by a health worker trained

in diabetes foot care • Assessment and management of new disease by a

health worker trained in diabetes foot care • Management of the person whose disease has

recovered

Minimum Skills Framework for the Africa Foot Care Initiative

• A primary-care vs. specialty-care-based approach incorporating community engagement

• Use of diabetes care champions that involve community leaders, especially in health care messages

• An explicit team approach that involves the community using pre-defined community engagement strategies

• Inclusion of psychosocial assessment and behavioural strategies

• On-going staff training• Comprehensive information technology that will include

electronic medical records and education

Statement of Need

• Need for an interdisciplinary approach, with a well-structured organization and appropriate facilities

• Need for concerted action by all people working with people with diabetes

• Need for specific uniform and consistent high standard guidelines

Þ to reduce the risk of development and progression of diabetic foot disorders

Þ to realize a uniform high standard of diabetic foot care

VisionMain goal: lower extremity amputation prevention

Secondary objectives: • Decrease practice variation • Increase patient satisfaction • Increase clinician satisfaction• Provide evidence-based care to people with diabetes• Reduce costs of care (achieved by 10% reduction in

costs of outside referrals and hospital utilization)• Improve clinic foot examination rates• Improve quality of life of people with diabetes

Initiative Framework

Patient Education and early foot intervention

Certified HWFaculty Curriculum

Selected HW

Clinical experience

Prepared clinical environment

Risk stratification

and intervention

tool

Risk score toolRelated Protocol

2-phase Initiative

• Phase I (Oct 12-Sept 13): Establishing the Initiative

• Phase II (Oct 13-Sept 16): Evaluating and building capacity for excellence

Phase I: Objectives

Develop an evidence-based Risk Stratification and Intervention Tool and its associated protocol

Develop a Foot Assessment and Intervention Curriculum for the African Region

Select and train health workers from 10 selected sites Establish & strengthen the capacity of 10 selected sites Start information activities with IDF member

associations Liaise with Health authorities to establish a foundation

for a community/ national engagement

Phase I: Work planOutcome 1: Develop tools and guidelines on Foot Care that are culturally appropriate and locally relevant

Output1.1 Develop a foot assessment and an intervention curriculum

Output1.2 Develop a risk stratification and intervention tool and its associated protocol to prevent complications of the foot

Outcome 2: Develop adequate organizational capacity to deliver quality interventions on Foot Care

Output2.1Health workers in the selected centres are trained on the use of the risk stratification and intervention tool in their clinical practice and have received a certificate of completion of the training

Output2.2Member Associations in the selected countries have established a working relationship with the relevant government health authorities and communities

Output2.3Proper working conditions are established in the regions and in the selected sites to deliver the interventions

10 selected sites: criteria• French or English speaking• Associated with IDF’s National Member Association• Established diabetes clinic• Supported by the Ministry of Health• Willing to partner with Sanofi • NOT a foot specialty centre• Highly motivated• Stability of staffing• Presence of a local diabetes care foot programme

champion• Ability to engage the local community in the diabetes

care programme

10 selected sites

The training process

Step 1Internal training

through e-diabetes (UNFM / IDF experts)

 

2/3 HCPs identified to

attend 1st training(1 doctor&1/2

nurses/ country)

Step 2One-week training in

Jo’Burg by UJ&USenghor

 Foot Care Diabetes Assistants

10 ‘Training teams’ trained

Step 3Accreditation

& quality controlby UJ&

USenghor  

PHASE II: Roll-out in 10 African countries (July 2013 and beyond) – pending Sanofi’s grant renewal

10 Satellite training centers’

accredited

Step 45-day training

of HCPs in training

centersby training

team&moderator from UJ or USenghor

 

Training accredited, report completed & HCPs trained

PHASE I: Initial training of 10 ‘training teams’ (Jan-June 2013) - confirmed

Organizational Capacity 1. Africa Diabetes Foot Care Technical Committee (Gate Keeper of the Project)

– Chair: Dr. Silver Bahendeka, IDF Africa Region – Vice Chair: Dr.Evariste Bouenizabela, IDF Africa Region – The Secretary & Africa Diabetes Foot Care Coordinator – Dr.Kaushik Ramaiya, IDF Africa Region – Representative from IDF Global office, Policy and Programmes department – Dr. Line Kleinebreil, UNFM e-education– Dr Z Abbas, International Working Group on Diabetes Foot, Expert Advisor– Prof George Ramahandridona, Expert Advisor – Prof. Andrew Boulton, Expert Advisor – Ms Fatima Cassim, University of Johannesburg– Dr. Christian Mesenge, Université Senghor, Alexandria

2. Diabetes Foot Care Coordinator: Maïmouna Mbaye 

Key stakeholders

10 selected sitesIDF Member Associations

MoH and health authorities

Budget (in EUR)Risk stratification and intervention tool

1st Workshop of the Technical Committee 12,000

2nd Workshop of the Technical Committee 12,000

Training of health care professionals

e-diabetes program - Recording and courses 8,000

Communication and invitations 2,000

Face to face training in Johannesburg 91,000

Engagement of 10 Centres in the selected countries

Kick-off meeting in Nairobi 20,000

Engagement of Communities

Production of education materials 6,400

Operational Costs

Project Coordinator, travels, miscellaneous 56,000

IDF support and expertise 50,000

Contingency 2,600

TOTAL BUDGET (EUR) 260,000

TimelineActivities

2012 2013

Oct Nov Dec Jan Feb Mar Apr May Jun July Aug SepActivity 1.1.1 Establish agreement                        Activity 1.1.2 Develop curriculum (by the Universities)

                       Activity 1.1.3

Peer review and revise - approval of Technical Committee                        

Activity 1.1.4 Select Faculty (by the Universities)

                       Activity 1.2.1 Literature & Best Practice Review

                       Activity 1.2.2

Meeting of the technical committee review of evidence (Telcon)                        

Activity 1.2.3

Workshop of the technical committee - 1 day (EASD)                        

Activity 1.2.4

Technical committee should meet again in the second semester (date to be confirmed) to review progress made                        

TimelineActivities

2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Activity 2.1.1 e-diabetes preparation

                       

Activity 2.1.2 Select participating health workers

                       Activity 2.1.3 e-diabetes program - Recording and courses

                       Activity 2.1.4

Communication & invitation - Invitations by IDF with recognition of Sanofi's involvement                        

Activity 2.1.5

Assess learning needs - 1st session to be dedicated to evaluate the level of knowledge and expectations                        

Activity 2.1.6

Evaluate and select candidates for F2F training (1 doctor&1-2 nurses/country)                        

Activity 2.1.7 Face to Face education and skills training

                       Activity 2.1.8

Accreditation of the 10 selected centers by Jo'Burg University and University Senghor                        

TimelineActivities

2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Activity 2.2.1

Face to face meeting with MoH in some countries                        

Activity 2.2.2

Co-joint letter to centers, MoH and patient associations                        

Activity 2.2.3

Face to face meeting in centers to present program                        

Activity 2.2.4

Analysis and audit of the selected Centers (equipment)                        

Activity 2.2.5

Selection of the project leader in the center and a project manager                        

Activity 2.2.6

Selection of diabetes associations - program presentation                        

Activity 2.2.7

Analysis and audit of existing activities/structure                        

Activity 2.2.8

Official meeting to start the program in Nairobi on 1-2 December 2012

                       

Activity 2.2.9

Regular communication with centers

                       

TimelineActivities

2012 2013Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Activity 2.3.1

Desktop research - foot care in Africa Region                        

Activity 2.3.2

Foot complications - record review and prospective data collection -                        

Activity 2.3.3

Background assessment of clinical environment                        

Activity 2.3.4

Meeting of the technical committee review of evidence (Telcons)                        

Activity 2.3.5

Meeting of the technical committee review of evidence (Telcon) - end of the program                        

Activity 2.3.6

Selection and adaptation of existing material                        

Activity 2.3.7

Support to develop activities - Equipment, space and material                        

Activity 2.3.8

Production of education material - e.g. Foot care kit for patients (Indian production)

                       

Phase II: Objectives

• Integrate knowledge and skills into clinical practice

• Monitor and evaluate use of risk stratification tool and protocol by selected participants

• Validate risk scoring tool

• Build capacity and develop ‘Model Diabetes Centres’

• Strengthen and consolidate the community engagement

Jan Feb Mar Apr May Jun July Aug Sept

Letter to Centrers, MoH & MA

Follow-up meeting with mgnt / MoH + engagement letter

Initial Audit of Centers

RiskStratTool & protocol implemented

Inform/liaise with stakeholders

Information with IDF MA

E-diabetes (1/week?)

Selection of HW / quizz

Mid-term Report

Foot Kit ordered

Manual sent to selected HW

F2F training in JoBurg

Follow-up/ practice in Centers

Accreditation of Centers

2° Audit of Centers

Final Report

End of Phase I

Thank you

The global advocate for people with diabetes

www.idf.org