Transcript Strengthening Health Systems for Chronic Care and NCDs

Strengthening Health Systems for
Chronic Care and NCDs:
Leveraging HIV Programs to Support
Diabetes Services in Ethiopia
Zenebe Melaku, ICAP Ethiopia
Ahmed Reja, Ethiopian Diabetes Association
Miriam Rabkin, ICAP Columbia University
Making the HIV-NCD connection
• In many resource-limited countries, HIV scale-up has created
the first national chronic disease program.
• In these same countries, the burden of other chronic diseases,
including NCDs such as diabetes, is high and growing rapidly.
• We conducted a rapid proof-of-concept study to explore the
feasibility of adapting HIV-specific resources for use in a DM
program at Adama Hospital in Ethiopia.
• Following a baseline assessment, we adapted key strategies,
systems, and tools originally developed for the Adama HIV
clinic, and introduced them into the OPD for use with adult
DM patients. A follow-up assessment was conducted after six
months.
Intervention Package:
Strategies
Systems
Tools
Introduction of an “essential
package” of key services,
supplies, and equipment
Appointment and defaulter
tracking systems
Appointment books
Use of step-by-step protocols
to guide care
Training, clinical mentorship
and supportive supervision
systems
Charting tools, forms
and flow sheets
Emphasis on family-focused
care
Peer educator programs
Job aids
Identification of a limited
number of M&E indicators
Chart review/quality
assessment conducted and
used by clinic staff
Patient education
materials
• No new or experimental services were introduced
• No new clinic was created – DM patients were seen within OPD as before
• No additional support was provided for medications, laboratory testing or
transportation, and no new staff were engaged for implementation
• No changes were made to service delivery or staffing at the HIV clinic
% of charts with service documented
Services offered and documented at least once in the past 3 visits
(n = 260 patients)
100%
90%
82%
80%
82%
81%
80%
81%
77%
74%
70%
60%
45%
50%
56%
50%
49%
40%
30%
17%
20%
10%
2%
1%
3%
3%
6%
4%
5%
2%
0%
Weight
Blood
pressure
Fundoscopic Foot exam Neurologic Oral/dental Assessment
DM
Next
Medication
exam
exam
exam
of visual
education appointment adherence
acuity
provided documented assessed
Baseline
Follow up
Six-month outcomes included:
• Marked increase in documented service delivery with no added staff;
• Expansion of services to include peer education and point-of-service DM
screening for patient family members;
• Rapid improvement in standards of care.