"... and on the either side of the river was there the tree of life, which bore twelve kinds of fruit, and yielded her fruit every month: and the leaves of the tree were for the healing of the nations."Revelation 22.2

Diabetes

Majority of Kenyans (87.8 per cent) have never done a blood sugar test in their lifetime. Yet nearly two per cent of Kenyans (nearly one million people) have raised blood sugar levels according to the Kenya STEPwise Survey for NCDs Risk Factors 2015 Report.

CHAK is implementing three projects addressing the burden of diabetes in Kenya.
 


Base of the Pyramid (BoP) 
CHAK has implemented the BoP project since 2012 with the support of Novo Nordisc. The BoP project covers 75 CHAK health facilities and their host communities spread in 23 counties, with the objectives of improving access to quality, affordable and sustainable insulin, improving clinical, patient and community based management of diabetes and giving information, awareness and education at the community. The project also works closely with the MOH to build the national capacity of supervision, data collection and reporting as well as monitoring and evaluation.
 

Action for Diabetes in Kenya (AFORD-Kenya)
This is a two-year project supported by WDF, which is implemented in 20 CHAK and 30 county government health facilities in Kisii, Nyamira and Kericho counties. This project started in 2017 and ends in 2019. 

The project’s objective is to promote early diagnosis of diabetes by promoting community information, education and awareness, screening at community level and improving linkage to enrollment for treatment and care at the health facility level. 

The project works in collaboration with the BoP and Novartis projects to improve access to insulin and oral hypoglycaemics for enrolled clients. Joint implementation with the counties ensures support from the devolved governments, improves sustainability and continuity of the project activities.
 

Novartis Access Project
This is a two-year project supported by Novartis and implemented across 50 CHAK Member Health Units in 20 counties. 

This project seeks to promote community-based awareness and education and screening for diabetes to promote early diagnosis and enrollment for treatment and care. 

The project also supports capacity building of health care workers to improve the quality of care. At community level it works with psychosocial support groups to raise the level of self-care and adherence to treatment.
 


All the three diabetes projects are complementary to each other and enable CHAK to achieve more coverage, community awareness for early diagnosis, improve care and treatment, data collection and reporting and supervision. 

The CHAK programme works with the private sector to improve laboratory diagnostics and follow monitoring of blood sugar control. In this regard, Meditec Systems has placed HbA1c machines in CHAK MHUs. The overall objective of the CHAK diabetes projects is to contribute to the World Health Organization target of halting the rise of diabetes and obesity by 2025.

Awareness and education
In 2017, a total of 86,251 persons were reached with messages on diabetes and the associated risk factors. 

These messages were passed through distributing IEC materials to communities, at health facilities and through mass media. 

Screening 
Screening for diabetes is done through outreaches and at health facilities. In 2017, the CHAK diabetes programme conducted a total of 110 community outreaches where 10,474 persons were screened for diabetes. Those found with abnormal sugar levels were referred to health facilities for further evaluation and treatment.

To facilitate screening for diabetes, CHAK distributed 401 glucometers and 12, 950 glucose test strips to MHUs. Further, a total of   118 community health volunteers (CHVs) were equipped with glucometers.

Risk factor evaluation for clients attending outreaches, targeting BMI, smoking, obesity, level of physical activity and alcohol abuse was also undertaken and the clients advised on strategies to minimize the risk factors.

Capacity building 
To improve the capacity of MHUs offering comprehensive diabetes care, the CHAK diabetes programme supports continuous mentorship to health care workers. In 2017, a total of 337 health care workers were trained using the strategy. 

Treatment and care 
In 2017, a total of 8,915 patients were offered diabetes treatment in CHAK MHUs.  More than 90 per cent of the MHUs accessed and dispensed supplies under the BoP access price of Ksh500 as compared to Ksh1,500 in the private for profit health sector.  
CHAK has facilitated establishment of 54 diabetes psycho social support groups to promote self-management of diabetes and improve adherence and control.

Equipment 
HbA1c screen, an important blood sugar control monitoring indicator is available in four CHAK MHUs, namely, AIC Litein, AIC Kapsowar and Nyanchwa Adventist hospitals as well as Baraka Health Centre in Nairobi through a placement arrangement with Meditec Systems. Meditec has supplied Siemens Vantage DCA HbA1c machine in the facilities.

CHAK-MOH collaboration 
The National Diabetes Control Programme, Division of Non-Communicable Diseases, (MOH) in partnership with CHAK conducts support supervision to assess the implementation of diabetes services. 

In 2017, the team visited IcFEM Dreamland Hospital, Friends Lugulu Mission Hospital and Mission of Mercy Medical Clinic in Bungoma, ACK Namasoli Health Centre, Ingotse Health Centre and Chebwai SDA Dispensary in Kakamega and COG Kima Mission Hospital in Vihiga county.


 

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