Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in Kyrgyzstan. Diabetes prevalence is significantly underestimated, and many people remain unaware and undiagnosed. Currently approximately 25,000 people with diabetes are registered in the National Diabetes Registry, whereas the IDF Diabetes Atlas estimates the number to be 132,200, corresponding to a prevalence of 4.3%. Even amongst those who are diagnosed the condition is poorly treated and undermanaged.In Kyrgyzstan, there is no national policy on NCDs and there is no organisational structure to coordinate diagnosis, treatment and prevention of diabetes.There is a severe shortage of human and financial resources, and the general practitioners (GP) lack skills in diabetes management, supervision and support. Most people with or at risk of diabetes are never referred to secondary or tertiary levels of the health care system. In addition, the primary care clinics do not have the necessary equipment to perform screening and providing basic care, precluding timely diagnosis and prevention of severe complications.Public awareness about risk factors, prevention and self-management is virtually non-existent and due to prevailing myths there is a widespread resistance to being screened and diagnosed, out of the fear of being stigmatised and excluded from the community. The problems of diabetes are especially serious for elderly due to poverty, illiteracy and unemployment.Thus, there is a great need for increasing awareness, creating equity, improving access and quality of care.The aim of this project is to prevent diabetes among high risk groups, especially elderly, and to improve the quality of life for people living with diabetes in the Issyk Kul, Chui, Bishkek and Batken regions of Kyrgyzstan.
In May 2007, WDF granted support to DanChurchAid (DCA) to conduct a feasibility study for a diabetes project in Kyrgyzstan. This current project is a consequence of that evaluation. It is the first of its kind in Kyrgyzstan, and the broad approach is expected to lower the incidence of diabetes by addressing risk factor reduction and by improving prevention and treatment of complications. If the project is successful, an expansion to the remaining four regions is likely.The project has four specific aims: 1) help people with diabetes to self-manage their disease; 2) improve the quality of and access to medical services; 3) raise awareness about diabetes and associated risk factors; 4) protect and promote the rights of people living with diabetes.Through collaboration with the Diabetes Association of Kyrgyzstan DAK, the Resource Centre for Elderly (RCE), ADRA and HelpAge International, DCA will target 170 already existing self help groups for elderly and establish 15 new peer support groups for diabetes patients.The objective of both the self-help and peer support groups is for people to learn about self-management, early recognition of complications and their rights in terms of access to health care. In addition, the participants will provide each other with social support, advice and motivation. These groups will also serve the purpose of information sharing and dissemination to families and communities.Standardised guidelines on DM and its management along with educational materials will be developed. Social workers from the implementing NGOs will receive training and be responsible for ongoing support and consultations to the groups. The treating GP will be responsible for referring people with diabetes to the peer support groups.Curriculum on primary and secondary prevention and care will be developed for primary level medical staff. A training of trainers programme for 150 GPs will be carried out. In turn they will train the remaining 320 GPs in the intervention area. This is expected to improve primary prevention, early diagnosis and treatment, and to facilitate self-management to enable people to better control their diabetes. The GPs will also be trained in addressing awareness, social and specific needs of elderly etc. to make their approach and attitude towards elderly and people with diabetes more positive.14 endocrinologists will receive training in complex case management and secondary complications like diabetic foot, retinopathy and renal diseases.Approximately 200 nurses working at the primary health care facilities will undergo training in diet and nutrition counselling, basic foot care, appropriate insulin injection techniques and monitoring of risk factors to enable them to provide advice on self-management.Due to the scarcity of resources at primary level, the project will strengthen health clinics by providing basic screening equipment.Annual screening events in each target region will be conducted to increase awareness among the general population and to encourage people at risk to get tested. This will also provide a basis for improved surveillance on the true diabetes prevalence in the country. DAK, the Ministry of Health and the family medical centres will collaborate to improve data collection.On a broader level, the project will facilitate dialogue between civil society groups and local authorities. Advocacy campaigns, local events and roundtable discussions with ministries etc. will raise public awareness and provide a basis for lobbying decision makers to prioritise diabetes. In addition, regional media campaigns will be launched.
• 71 peer support groups for people with diabetes established and trained• 181 existing self-help groups trained• 420 GPs trained• 29 endocrinologists trained• 383 nurses trained• 25 primary health care clinics provided with basic screening equipment• DAK regional office in the Batken region established• 4110 people sensitised through DAK office• 75 local awareness events conducted• 12,730 people screened• 8 roundtables conducted