Improving diabetes care in sub-Saharan Africa

The rise in type 2 diabetes is a worldwide epidemic. In sub-Saharan Africa, where diabetes competes with communicable diseases for scarce financial and staff resources, the effects are potentially disastrous. People in this region with type 1 diabetes have a very short life expectancy. What is needed to address the pending crisis?

In Africa, a continent already burdened with the serious problem of communicable diseases such as malaria, HIV and tuberculosis, the incidence of non-communicable diseases such as high blood pressure and diabetes is on the rise. The prevalence of type 1 diabetes is reportedly low (about 35,000 people), due either to a lower incidence, under-diagnosis or misdiagnosis, and prognosis is poor (life expectancy of five years). Meanwhile, an estimated 7 million sub-Saharan Africans had type 2 diabetes in 2000 and this is expected to rise to almost 19 million over the next 30 years.

As the number of people with diabetes rises, the increase in diabetes-related health complications and the need to manage these will put pressure on the health care systems of countries that are already seriously lacking in resources. There are two challenges on this front – to halt the rise in type 2 diabetes related to increasing urbanisation and obesity, and to provide accessible care and medicines for those diagnosed with diabetes.

The International Insulin Foundation examines the barriers to access to diabetes care in sub-Saharan Africa and offers an 11-point action plan for the region. These are based on a number of findings, including:

• At present, health systems in sub-Saharan Africa are focused on treating acute (sudden onset and limited in time) illnesses rather than chronic (ongoing) illnesses.
• Many countries in this region do not have a policy framework in place for non-communicable diseases, including diabetes.
• One of the major obstacles to diabetes care may be the cost to the patient and the health system of routine testing and the availability of actual tools for the exams. In Mozambique, only 18 percent of health facilities are able to measure blood glucose concentration and only eight percent test for urinary ketones.
• Health care workers in Africa generally have a poor understanding of diabetes management, especially in rural areas.

To improve the lives of patients with both types of diabetes, trained health care workers, a functioning health care system, a functioning referral system, guidelines and the ongoing availability of drugs are needed. Among the actions recommended for sub-Saharan governments are the following:

• There must be strong political will to set up a national diabetes programme.
• Data is needed on the size and extent of the country’s diabetes problem to help develop political will and effective care planning. A diabetes association will be critical to push this.
• A national diabetes programme and policy is needed to organise the health system in order to provide the care, medicines and tools needed.
• The programme should tackle prevention as well as the problems of access to care and its affordability.
• Health workers in training and also those already practicing need to be educated on diabetes.

Source(s):
‘The Diabetes Foundation Report on implementing national diabetes programmes in sub-Saharan Africa: Overview’, International Insulin Foundation: London, by David Beran, 2006 Full document.
‘Diabetes care in sub-Saharan Africa’, The Lancet 368, pages 1689-1695, by David Beran and John S. Yudkin, 2006 Full document.
 

Funded by: The Diabetes Foundation, World Diabetes Foundation, WHO Essential Drugs and Medicines Unit, and Barnett and Sylvia Shine No. 2 Charitable Trust

id21 Research Highlight: 15 March 2007

Further Information:
David Beran
International Insulin Foundation
Diabetes and Cardiovascular Disease Academic Unit
Royal Free and University College Medical School
The Archway Campus
2-10 Highgate Hill
London N19 5LW
UK

Tel: +44 (0) 20 72885347
Fax: +44 (0) 20 72883382
Contact the contributor: david.beran@access2insulin.org

International Insulin Foundation

Other related links:
'Assessing access to insulin in Mali, Mozambique and Zambia'

'Treating diabetes in Ghana: is there a role for traditional medicine?'

'Five years on… Improvements in diabetes care in Trinidad and Tobago'

'Keep it in the family - preventing cardiovascular disease in The Gambia'

'Best of both worlds? Public and private sector care for people with diabetes in Trinidad'

World Diabetes Foundation: Media Backgrounder on diabetes in the developing world (PDF)

World Health Organization Diabetes Programme