This page contains a Flash digital edition of a book.
Mbanya_US_endo_Cardiology_book_temp 21/12/2009 10:27 Page 18
Current Issues International Health and Diabetes
The Diabetes Declaration for Africa—Call to Action
46
The IDF-Africa, the WHO-AFRO, and the African Union call on the governments of African countries, non-governmental organizations,
international donor agencies, industry, healthcare providers, and all partners in diabetes to ensure:
adequate, appropriate, and affordable medications and supplies awareness of diabetes among healthcare providers and in
for people living with diabetes; the community;
earlier detection of and optimal quality of care for diabetes; a truly integrated approach that utilizes the whole health
effective efforts to create healthier environments and to workforce to address infectious and non-communicable
prevent diabetes; diseases simultaneously;
the identification and dissemination of information, education, government commitment to reducing the personal and public
and communication to empower people with diabetes to access health burden of diabetes; and
appropriate diabetes services and improve self care; partnerships and collaboration within and between government
equitable access to care and prevention services for people with sectors, private sectors, non-government organizations, and
or at risk for diabetes; communities to create community and workplace environments
that promote better health. n
The Cost of Diabetes guidelines for the management of diabetes.
37–39
However, in most
Healthcare in most of SSA is almost entirely privately purchased. countries a lot still has to be done. Limited financial resources are a major
Considering that the majority of the poorest people worldwide live in handicap even where there is scientific information and the political will
SSA, this statement intuitively signals disaster. A recent study by Kirigia is available—both of which are still largely lacking in many SSA countries.
et al.
33
clearly demonstrated that the cost of diabetes care is going to be It is possible to set up effective diabetes care at the peripheral level using
overwhelming for the poorest countries of the region. This study shows basic resources in terms of personnel and equipment. Nurse-led care
that while the direct cost of diabetes per person with diabetes is only a including education was shown to be successful in a rural resource-
fraction (<25%) of the gross national income (GNI) per capita for the 12 limited setting over an 18-month period.
40
However, it would be a real
richest countries, the direct cost for the 34 poorest countries of the challenge to translate such experiments over a larger scale and a much
region is 125% of their GNI per capita (see Figure 4). For these poorest longer period. Work carried out by the International Insulin Foundation
41
countries, the total cost (direct and indirect) of diabetes per person with identified the main areas to be addressed in the fight against diabetes in
diabetes is more than double the GNI per capita. SSA, encompassing policy improvement, better organization, and delivery
of care and patient education. Whiting et al.
42
reviewed challenges to the
The few studies on the cost of diabetes care (usually on small samples) delivery of diabetes care in a few countries that had reported data on
that have been carried out in the region confirm the above estimates. diabetes healthcare delivery, and could still identify the following barriers
Akoussou-Zinsou and Amedegnato
34
reported in 2001 that the direct to adequate diabetes care:
cost of diabetes care at a teaching hospital in Togo was $342 and $110
per person for ‘complicated’ and ‘uncomplicated’ patients with patient attendance is poor (there are many reasons for this and more
diabetes, respectively. The estimated GNI per capita for Togo at the time work is required to explore them);
was approximately $385. Chale et al.
35
reported an average annual direct consultation times are very short, leaving little or no time for
cost of diabetes care in Tanzania in 1989–1990 of $287 for a patient patient education;
requiring insulin and $103 for a patient not requiring insulin. In a study staff levels are inadequate and more use could be made of trained
on type 1 patients with diabetes in Sudan, Elrayah et al.
36
reported a nurses and other health workers;
partial direct cost of care for each child with type 1 diabetes of $283, in staff training is limited, and continuing education or in-service
a country with a gross domestic product (GDP) per capita of $300 and a training, especially of lower cadres, is needed;
per capita government expenditure on health of $3. These data complications are not monitored or evaluated in a systematic manner;
undeniably indicate that the cost of diabetes care constitutes a huge control of blood glucose and blood pressure is very poor;
burden on society in SSA. In the absence of a publically funded referral systems are inadequate;
healthcare system, these costs are borne almost entirely by patient education is almost non-existent;
individuals—individuals who are among the poorest people in the organization of services is generally poor; and
world. In this context, poor disease prognosis with high morbidity and better record-keeping will assist with improvements in care.
mortality seem to be the unavoidable outcomes.
Therefore, even when diabetes care programs are introduced, a lot will
Prevention and Care still need to be done to enable them to meet their objective of
Many SSA countries have made significant efforts in initiating and reducing morbidity and mortality linked to diabetes and its
improving care for diabetes and other chronic diseases. A few countries complications. A few of the drawbacks above relate to inadequate
now have established successful national diabetes programs and healthcare staff levels as well as patient-related factors. Patient
18 US ENDOCRINOLOGY
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124
Produced with Yudu - www.yudu.com