Integrating diabetes and hypertension control in the NCD platform, Malawi

Objectives

To consolidate and refine the Malawi MoH national diabetes/NCD response, with emphasis on capacity building and quality of care.

Approach

This second phase national programme support to Malawi from WDF will build on outcomes, structures and procedures successfully established under WDF14-938 (first phase national diabetes/NCD response support) and other preceding WDF-funded projects in Malawi (since 2008) and integrate interventions across all three regions of Malawi.

This second phase programme will encompass:

District level awareness raising, prevention and community mobilisation
Screening and outreach clinic services
Integrated primary level care/onwards referral
Patient support and monitoring with focus on adherence and retention
Systematic patient/cohort level monitoring and evaluation, incl. with indicators on service delivery and supply chain

Noting the considerable achievements of preceding WDF funded projects (in particular WDF14-938), this second phase will also seek to consolidate a health system re-orientation and enhance quality of diabetes/NCD care through:

Ongoing training based on a ‘mentorship model’ approach at clinic level, already applied by MoH and PiH in a pilot district and also based on PiH interventions in similar sub-Saharan Africa settings
Analysis of supply chain and implementation of activities to address pipeline shortages
Implementation of a ‘triaging model’ with multiple initial screenings (diabetes, hypertension, HIV, TB, nutrition etc) to be carried out at primary level with onwards appropriate care and referral; and
Integrated HIMS patient data systems to be strengthened
All previously prepared and endorsed training, education and awareness material produced through WDF grants will be revised and adapted, incl. materials concerning diabetes foot care and eye care.

Notably, this second phase will also include type 1 diabetes based on WDF fundraiser activities and on PiH experience, with focus on the four referral hospitals in Malawi.

Results at completion

1,596 community level awareness events convened and radio programmes aired
1,300 DAM/community leaders provided basic training on diabetes/NCD risk factors and screening
112 screening camps convened, 27,500 at risk people screened
1,786 HCPs trained on diabetes/NCD care, representing 138 diabetes/chronic care clinics at different levels
Targeted clinics provided necessary equipment and at least 130,522 patients to have received improved care, education and monitoring