When the National Diabetes Control Programme (NDCP) was launched in India in 1987, funding was inadequate. More recently the national programme for cardiovascular diseases, diabetes, stroke and cancer has been initiated as a pilot initiative in 100 districts in India. The IDF estimates that there are 61 million people with diabetes in India (IDF, 2011), and the number continues to grow rapidly.Assam, located in the northeast part of the country, is a less developed state with limited resources. At the state level very little is being done for the prevention and treatment of diabetes. Diabetes care is especially inaccessible for the rural poor.The project aims to create a scalable and replicable platform for type 2 diabetes prevention, screening, and management for the rural poor in Assam.
The project will be carried out by the Health Management and Research Institute (HMRI), in collaboration with the Department of Health and Family Welfare of Assam.HMRI has already set up Sanjeevani, a mobile health service consisting of 80 mobile health units (MHU) that screen for chronic diseases, refer patients to the nearest diagnostic facilities, provides one month of medication, and supports disease management through monthly visits. The MHUs already cover 6,500,000 people, and this project will increase coverage to 13,000,000 people in 7,000 villages.HMRI will leverage its existing infrastructure, human resources, technology, and network to better reach people with type 2 diabetes in rural Assam.26 parking place clinics (PPC) will be converted into basic telemedicine centres that register patients, record vital information, and connect patients to specialist physicians via videoconference. The MHUs will use the innovative Dox-in-Box® digital medical technology. Patients’ vital signs are captured and uploaded onto a server. The information is then sent to a physician who can use it for virtual consultation with the patient.Physicians will be available over videoconference during operating hours, and patients can speak with physicians through Sanjeevani 24 hours a day, 7 days a week.HMRI will train 60 paramedics, 5,280 health workers and 5,000 community resource people, including 4,800 accredited social health activists (ASHA). Health workers form a crucial component of this project because they are responsible for educating the community, as well as serving as role models—mobilizing, monitoring, and following-up with people with diabetes.Primary prevention activities will be conducted for 6,500,000 people, including primary prevention activities for adolescents and awareness of gestational diabetes (GDM) in pregnant women. HMRI will create educational material in the form of text, visuals, materials targeted at children, and performance folk art. These materials will provide information on diabetes, risk factors, GDM, diabetes-related complications, and encourage proper diet and exercise, as well as health check-ups.ASHAs are incentivized health activists that serve as liaisons between local communities and the national public health system. Each ASHA is required to conduct one primary prevention session with either school children, pregnant women, or the elderly once per month. ASHAs are not only trusted members of their communities, but also provide an effective way of disseminating knowledge.ASHAs will pre-screen community members for diabetes using questionnaires, waist circumference, and BMI, and then mobilize patients to visit the MHU. The MHU will screen for diabetes and refer people to physicians for diagnostic confirmation and treatment. The physicians will monitor and manage people with diabetes by making recommendations for diet and exercise, as well as prescription medication. ASHAs will follow up with patients on a regular basis and encourage patients to make quarterly visits to a healthcare facility.People with diabetes will undergo yearly screening for diabetes-related complications. HMRI will manage three complications: retinopathy, nephropathy, and foot care.HMRI will build a referral network that includes physicians at primary health centres that can diagnose and prescribe treatment for type 2 diabetes, monitor pregnant women with diabetes, and perform complex deliveries and manage diabetes-related birth complications. HMRI will supplement this strong referral network by monitoring and following-up with patients, ASHAs, and paramedics.This project will focus only on the population living below the poverty line in Assam.
• 60 paramedics trained• 472 mobile health workers trained• 5151 accredited social health activists trained• 9,499 community resource people trained• 666,417 assessed for risk factors• 398,078 screened for diabetes• An estimated 6,5 mio people reached with awareness and health promotion activities• 30,460 people with diabetes provided routine care