National Diabetes Programmes

A Guide to National Diabetes Programmes

A National Diabetes Programme guide is currently in press. This builds on the 2003 NDP Toolbox and sets out considerations and source material for developing and implementing NDPs. Topics 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.

What is a National Diabetes Programme

A National Diabetes Programme is a systematic and co-ordinated approach to improving the organisation, accessibility, and quality of diabetes prevention and care which is usually manifest as a comprehensive policy, advocacy and action plan covering the:

  • Main types of diabetes ie type 1 diabetes, type 2 diabetes and gestational diabetes
  • Whole continuum of care from primary prevention to treatment and palliative care
  • Resources, services and systems that support prevention and care 

Where lack of resources or political support preclude the development of a comprehensive National Diabetes Programme, single component  or ‘stand alone’ programmes can raise awareness of diabetes, bring worthwhile gains and may  be helpful in paving the way for a more comprehensive programme.  Single component programmes may focus on:

  • One aspect of diabetes such as foot problems, visual impairment, kidney disease
  • One aspect of care such as clinical management guidelines, data collection workforce training 

Regardless of whether they are comprehensive or single component, National Diabetes Programmes can be defined as formal strategies for improving diabetes policy, services and outcomes that encompass structured and integrated or linked activities which are planned and co-ordinated nationally and conducted at the national, state or district, and local level.

National Diabetes Programmes must be documented and have stated goals and objectives, supported by a strategic plan, specified timeframes and milestones and dedicated funding, and a means of evaluation.  Approval and endorsement of, and leadership from the Ministry of Health is vital.

The core elements of a comprehensive national diabetes programme are:

  • Primary prevention ie preventing the development of risk factors
  • Secondary prevention ie preventing the development of diabetes
  • Tertiary prevention ie preventing the development of complications through early diagnosis and effective monitoring, treatment and care of people with diabetes
  • The funding and systems that underpin prevention and care ie:
    • workforce and services
    • medication, equipment and supplies
    • information and communication systems
    • monitoring and surveillance systems
    • clinical policy, guidelines and governance
    • resource allocation

Contents:

Section 1 -  Getting Started

  • Making the Advocacy Case for Diabetes
  • Developing a Framework for a National Diabetes Programme
  • Establishing a National Diabetes Organisation

Section 2 -  Determining the Extent of the Problem

  • Conducting a Situation and Needs Analysis
  • Conducting a Baseline Prevalence Survey
  • Assessing the Cost of Diabetes
  • Assessing Community Awareness

Section 3 -  Preventing the Problem

  • The Individual or High Risk Approach
  • The Population / Environmental Approach

Section 4 -  Addressing the Problem

  • Developing a Community Awareness Campaign
  • Early Diagnosis of type 2 Diabetes
  • Routine Care and Monitoring of Diabetes
  • Patient Education
  • Psychological Issues
  • Developing and Implementing Guidelines
  • Developing the Diabetes Workforce and Services

Section 5 -  Evaluating Progress

  • Collecting Diabetes Data
  • Evaluating National Diabetes Programmes

Section 6 - Where to next?

  • National Diabetes Programmes of the future
  • Standards for National Diabetes Programmes

Section 7 - Who can help?

  • IDF Global Infrastructure
  • IDF Regional Infrastructure
  • IDF Task Force on Diabetes and NCD Prevention, Policy and Practice

Section 8 - Additional Information

  • Suggested Readings
  • Useful Definitions

The guide will be available shortly along with a PowerPoint presentation on key aspects of the Guide.

Standards for National Diabetes Programmes

In the interests of developing a common understanding and language around National Diabetes Programes at the global level, the IDF Task Force on Diabetes and NCD Prevention, Policy and Practice has developed an initial set of 10 core standards for National Diabetes Programmes. 

  1. A National Diabetes Programme exists and is publicly available
  2. The goals and objectives of the National Diabetes Programmes are clearly documented
  3. The National Diabetes Programme is endorsed and led or auspiced by the Ministry of Health
  4. The National Diabetes Programme has been allocated dedicated funding by the Government
  5. The National Diabetes Programme includes:
    • type 1 diabetes (this may  not be applicable in, say, Pacific Island countries)
    • type 2 diabetes
    • gestational diabetes
  6. The National Diabetes Programme covers specific areas eg:
    • ensuring equitable access to prevention and care services for all who need them
    • workforce development
    • the provision of adequate services, equipment and supplies
    • information systems
    • clinical governance/ guidelines and protocols
  7. There is a documented implementation plan for the National Diabetes Programme
  8. An appropriately constituted steering committee or group is tasked with overseeing the implementation of the National Diabetes Programme. This should include a range of stakeholders eg:
    • government authorities/officials
    • specialists and Primary Health Care Workers
    • business leaders
    • community leaders
    • diabetes association, professional societies or, action groups
    • relevant national/international health organisations/agencies
  9. The National Diabetes Programme takes a Patient Centred Approach ie:
    • people with diabetes are consulted about their needs
    • people with diabetes are represented on the committee responsible for the NDP implementation
    • the NDP includes a focus on ensuring equal access to health care regardless of geographic location, socio-economic status, language, culture or indigenous status
  10. The National Diabetes Programme involves monitoring and surveillance of:
    • prevalence and incidence
    • access to and outcomes of routine clinical care and services
    • availability of essential medications and supplies
    • cost of diabetes to the health system/government
    • cost of diabetes to individuals/families or carers
    • community awareness
    • workforce: distribution, skills, numbers

Over time it is intended to refine and expand the standards and add measurable indicators by which national programmes can be assessed meaningfully and compared. If you have comments please send them to Maria Gomez.

Useful references