Published: 27th Mar 2020

Objectives & approach

According to tthe WHO the mean body mass index in Fiji for males is close to 27 kg/m2 and above 29 kg/m2 for females. Non-communicable diseases are estimated to account for 77 % of all deaths in Fiji and in 2008 a total of 65 % of the total population was estimated to be overweight and 30 % to be obese. The International Diabetes Federation (IDF) estimated 10.5 % of the adult population to have diabetes resulting in more than 1,000 deaths a year in 2012 and furthermore 143,000 people are estimated to be living with undiagnosed diabetes in Fiji. Annual reports from the Ministry of Health suggest that the rates of admissions to hospitals for diabetes mellitus and its complications have doubled over the past 5 years.

Objectives
The project seeks to strengthen capacity of health service providers, to equip the health facilities for improved diabetes management including diabetic foot care and finally to improve health seeking behaviour among the communities and especially among the high risk population as well as people already living with diabetes.

Approach
The project will begin in the Central Medical Division and expand to other medical division in the following years.

To strengthen capacity of health service providers the project will revise the existing training manual, guidelines and protocols on diabetes and diabetes and foot care. There will be an increase in number and quality of the health care providers to manage diabetes and diabetic foot infections. A practical reporting system on diabetes related cases will be established and finally training and learning activities consisting of modules with a 6 month follow-up will be conducted for division hospitals, surgeons, nurses, primary care physician and students organised by centrally located project officers at 3 divisional hospitals. The training content will be screening techniques, patient training, management, danger signals, referral system, toolkits and case stories.

Another important part of the project is to equip health facilities with essential medical equipment and supplies for improved management of diabetes including diabetic foot care. A standard list of essential medical equipment, drugs and supplies will be developed and should by the end of the project be available in each of the targeted health centres. The project will also procure and ensure the availability of basic equipment as well as develop a tool for the Ministry of Health at central and divisional levels to monitor availability and use of commodities and equipment to ensure realistic projections and lead time for procurement and delivery to the health facilities.

Finally as stated above the project will improve the health seeking behaviour among communities especially the high risk population and diabetic patients, particularly on diabetic foot care. A review and revision of existing materials on creating awareness on health seeking behaviour for diabetes will be done together with an identification of gaps and develop supplementary materials for awareness creation. All multi-media networking partners will be mapped out to develop a media strategy and work plan for innovative approaches disseminating public information on prevention of diabetes and diabetic foot care. Community based programmes, peer education and workshops will be conducted to create awareness using community, private sector, religious groups and NGOs in the implementation process.

The project is intended be become part of the Ministry of Health to continue to provide quality of clinical care and management of diabetic foot care beyond the life of the project.

Expected results
• Standardisation of guidelines & training materials
• Decreased admissions & amputations due to diabetes
• Increase in consultation on diabetes
• 476 health care professionals trained