According to the International Diabetes Federation, 61.3 million people live with diabetes in India (IDF, 2011). This number is projected to increase to 79.4 million by the end of 2030. One of the risk factors attributed to this increase is intrauterine programing and exposure to high blood glucose due to GDM in the mother. In addition GDM during pregnancy confers a much higher risk of poor pregnancy outcomes and maternal and perinatal morbidity and mortality. Women with GDM are also at a much higher risk of future diabetes which can be prevented through appropriate lifestyle measures.. A single initiative - screening women for diabetes during pregnancy thus has multiple benefits. The level of awareness of GDM is currently insufficient and universal screening of pregnant women for GDM has not yet been institutionalized.From 2010-2011, Jagran Pehel, a social initiative of one of the largest media conglomerates in India, implemented a WDF funded nationwide mass media campaign titled “A multimedia approach for awareness generation on gestational diabetes and management in selected districts of India” (WDF10-500), which created awareness for GDM and began to mainstream GDM in the maternal and child health programs.The project’s goal is to mainstream GDM in the existing public health delivery system and to ensure that action is taken by political stakeholders in four states in India.
The project is a follow-up initiative to WDF10-500, and will provide technical support and advocacy for the effective mainstreaming of GDM in the public health system through state-level advocacy, GDM training of trainers (ToT) workshops for healthcare providers, and the distribution of GDM information kits.Advocacy meetings will be held with government officials and relevant stakeholders from each of the four states: Bihar, Jharkhand, Punjab, and Delhi. The purpose of these meetings will be to integrate the GDM screening program with existing health systems through local policy initiatives to include GDM screening as services offered to pregnant women, allocation of resources, and the creation of support systems for the program. Follow-up sessions with the local health authorities and local health officials will ensure the effective implementation of GDM management through the existing health delivery system.200 district level health representatives and private practitioners will be trained as trainers (ToT) and will initiate the cascading effect of ToT. These state-level trainers will be responsible for training 2,000 block-level doctors, who are then entrusted with the responsibility of training 170,000 accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs).With the intention of creating a network of informed health personnel, 200,000 information kits with guidelines for the prevention and management of GDM that were drafted at a National Forum on GDM will be translated into local languages and distributed through state and district level health department channels so that they can be used as guidelines by the ASHAs and ANMs.
• Health officials from Bihar, Jharkhand, Delhi and Punjab committed for mandatory screening of GDM in their district and undertake GDM test at the public health centres, reporting and community awareness.• Endorsement of all the developed IEC materials and the GDM guideline by the Health department;• Training of trainers of 231 doctors with subsequent organisation of orientation workshops for 3,208 ANMs and 12,589 ASHAs about GDM screening and management;• Sensitisation of more than 170,000 ASHA and ANMs through dissemination of GDM kit.