National Diabetes Programmes

Diabetes has been recognized at the highest international levels as being a serious threat to health and to economic development 1   2 . In 1989 the 42nd World Health Assembly passed a global call to action on the prevention and control of diabetes in the form of Resolution WHA42.36 1  and in response five regional declarations were adopted. The St. Vincent Declaration 3  in Europe brought immeasurable benefits globally by providing leadership, inspiration, motivation, and a role model on advocacy and action for diabetes which had a worldwide influence. It was followed in 1994 by the Declaration of the Americas, in 2000 by the Western Pacific Diabetes Declaration and Plan of Action, in 2006 by the Declaration and Diabetes Strategy for Sub-Saharan Africa, and in 2008 by the Kathmandu Declaration.

Resolution WHA42.36 also provided the mandate for the development of National Diabetes Programmes (NDPs). NDPs are the means by which countries explicitly allocate resources to prevent diabetes and care for people with diabetes, and therefore can be seen as an indicator of the commitment of countries to dealing with diabetes.

In 2006 there was a second landmark resolution: UN Resolution 61/225 2  on diabetes contained three core messages, the third of which called for:
“…Member States to develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their health care systems, taking into account the internationally agreed development goals including the Millennium Development Goals”

Survey of National Diabetes Programmes

Given the pivotal role that NDPs would need to play in answering the call of the UN Resolution, the IDF Task Force on National Diabetes Policy and Action surveyed the 202 IDF member associations in 2008 to determine the existence, content and implementation status of NDPs in their countries.

Just under half of the associations responded, and almost two-thirds (61%) of the 89 respondents reported that their country had a National Diabetes Plan. Overall three-quarters of the plans were being implemented. The status of NDPs in each country can be seen in Map 5.1.

Go to the map section and select the map of your choice

In two-thirds of countries with an NDP, the NDP functions as an integrated component of a national non-communicable disease strategy. One-third of countries reported that there was funding dedicated solely to the NDP.

The content of the NDPs were varied, however there were some themes that were consistently represented in the goals and objectives of most of the programmes (see Box 5.1). The survey demonstrated that there is a strong core of cohesive national activity on diabetes around the world. However, it also illustrates the need for a concerted effort to encourage and support countries without NDPs, and those whose NDPs are inactive, to develop and implement comprehensive prevention and care plans aimed at reducing the personal, family and societal burden of diabetes.

NDP Toolbox

To assist countries that need to design an NDP IDF is developing an 'NDP Toolbox'. This will set out considerations and provide source material for developing and implementing NDPs. Topics will include measuring the problem (disease prevalence, morbidity and cost), intervening to mitigate the problem (prevention, early diagnosis, services and care of people with diabetes) and evaluating the impact of the interventions.

Inevitably the success or otherwise of broad public health policy and advocacy interventions such as NDPs ultimately centre on the question of whether or not they are sustainable.  It is now clear that the movement that started 20 years ago with WHO Resolution WHA42.36, and is currently being re-invigorated by UN Resolution 61/225, is durable and has the capacity to mount a robust, sustained and successful battle against diabetes.

The background paper, National Diabetes Programmes, on which this summary is based is available in the Downloads section.

Box 5.1 National Diabetes Programmes goals and objectives

 

National Diabetes Programmes goals and objectives
The following themes consistently appeared in the respondents’ specification of their country’s NDP goals:
Raising public awareness: national promotion, information and education
Prevention: primary (reduce diabetes incidence), secondary (early diagnosis and behaviour change), tertiary (reduce complications, mortality, minimize impact)
Improve quality of diabetes treatment and care: accessible, community-based, multi-disciplinary teams, patient-centred approach
Ongoing professional development/training for diabetes care personnel (health workers)
Development of national clinical guidelines for diabetes
Support for research into diabetes
Establish a diabetes register (type 1 diabetes)

 

1: World Health Organization. WHA42.36 Prevention and control of diabetes mellitus. 1989. www.who.int/entity/diabetes/publications/en/wha_resol42.36.pdf

2: United Nations. A/RES/61/225: World Diabetes Day. 2006.

3: Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med 1990; 7 (4): 360.