GHF2008 – PS02 – Management of Chronic Disease II: Adapting Health Services, Engaging Communities

Session Outline

Parallel session PS02, Monday, May 26 2008, 16:00-17:30, Room 4
Chair(s): Fred Paccaud, Director, University Institute of Social and Preventive Medicine, Switzerland
Engaging with the Communities to Improve Diabetes Care  
Mapoko Ilondo, Director, Access to Health Programme, Corporate Relations, Novo Nordisk A/S, Denmark 
Community Participation for Chronic Disease Management 
Sanjib Sharma, Associate Professor, B.P. Koirala Institute of Health Sciences, Nepal 
Isfahan Healthy Heart Program: A Case Study of Community Participation in Iran 
Nizal Sarrafzadegan, Director, Isfahan Cardiovascular Research Center, Iran 
Health Systems Response to Chronic Disease
Rafael Bengoa, Director, International Observatory on Quality and Management of Chronic Conditions - Kroniker, Spain  

Session Documents

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Session Report

How can we integrate health care for chronic diseases so that patients are diagnosed, given proper treatment and an appropriate care plan so their disease does not worsen without proper follow-up? Can community engagement really make a difference?

Mapoko Ilondo (Director, Access to Health Programme, Corporate Relations Novo Nordisk A/S) states that diabetes is on the rise worldwide. Currently 246 million are afflicted and by 2035 the number will go up to 330 million mostly occurring in developing countries. Although diabetes can be diagnosed and treated, in many countries in Asia and Sub-Saharan Africa, 80% are unaware of their condition. Novo Nordisk (NN) has many projects where diabetes treatment plays a key role. The National Diabetes Program works with their affiliates all over the world to develop national strategies to prevent diabetes in their countries. Treating diabetes is not sufficient; we must reach out to the person behind the disease. In doing so, the patient is central in getting the best result from the programme. NN also has a policy to sell insulin to fifty least developed countries at 1/5th of the price it is sold in Europe. Unfortunately, this cost reduction does not always benefit the person in need. Due to the persistence of duties on insulin, that only government policy can change, patients can pay three to four times the price offered by NN.

Three cornerstones of the model for diabetes care are:

  1. Political will (government involvement is essential)
  2. The presence of a local champion (who is responsible for activity and has a sense of ownership)
  3. Education of health care professionals.

Poverty is the most important limiting factor in accessing health care. Partnerships must be made between civil societies and pharmaceutical industries in order to provide global access to diabetes care, especially for kids and families living at the "base of the pyramid". In conclusion, to improve global access to diabetes care, campaigns to raise awareness on symptoms of the disease must be implemented, communities and local champions must be engaged, and most importantly, quality care and monitoring to diagnosed patients must be given.

Coming from one of the poorest countries, Sanjib Sharma (Associate Professor, B.P. Koirala Institute of Health Sciences) has been able to achieve the nearly impossible task of diagnosing and documenting patients with chronic diseases. Despite the lack of doctors, health care centres, and innovative technology, Dr. Sharma and his colleagues, with the help of government and community involvement, the support of local leaders and civil societies, and the education of teachers, has been able to create public awareness, train personnel, develop screening measures, collect and analyze data, and do follow-up screening of subjects. They have been able to improve patient care through early detection of problems. In the communities affected, there is now a reasonable control of diabetes and hypertension.

Despite the shortage of manpower and increasing expectation of patients, the biggest obstacle they face arises after a positive diagnosis: they have no treatment to offer due to lack of funds. They have, as a short term solution, been contacting pharmaceutical companies to give the medicine at 50% discount and collect local fundraising from the community. As for the long term solution, they still do not have an answer to this question.

Rafael Bengoa (Director, International Observatory on Quality and Management of Chronic Conditions) works on adapting health service for chronic conditions. Chronic diseases are prevalent in both rich and poor countries. The problem we are faced with is the system is set-up to deal with acute diseases. The system needs to be fine-tuned to accommodate the growing problem of chronic diseases. At the moment, doctors do not have the capacity to manage chronic conditions and are not able to deal with the chronic disease epidemic.

A typical health care model is a patient appears, is treated, is discharged and disappears off the radar screen. An improved health care model for chronic diseases is: at risk population is identified, patient appears, is treated, is empowered, discharged with a care plan and never disappears from the radar screen. There are multiple levels to improve health care, the national and regional levels, integrated medical care organization and the practical level. However, these systems are not yet aligned; therefore no usable system is in place to improve quality of care.

A stratification strategy needs to be implemented where patients are organized and treated according to their needs (meaning no 'one size fits all' care). Likewise, a care manager who is trained to do good patient education and manage chronic conditions is needed; this shifts care giving to non-physicians. Self-management should be implemented, where patients are responsible for their own health.

Issues brought up during discussion included the fact that adapting health services in these countries is a difficult task because on one hand, they have to develop new services for chronic diseases while on the other they are still strengthening the current system for acute diseases. Chronic care requires a profound reworking of the current system; continuous care is a challenge despite the fact that we have the tools we need to move on.

Vertical Integration - nobody knows how to vertically integrate chronic diseases, many examples have been offered, but the incentive system has to be changed and the government needs to be involved in the integration effort. Typically, Ministries of Health are not allowed to do vertical integration, as money that comes in is already earmarked. If we are able to come up with the data showing a link between chronic diseases, then the possibility exists of collaborating with other vertical programmes.

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