The Sri Lanka Diabetes and Cardiovascular Disease Initiative (SLDC) is a three-year national-level project (started in October 2016) led by the Ministry of Health, Nutrition and Indigenous Medicine and funded by the World Diabetes Foundation (WDF).The World Diabetes Foundation was established by Novo Nordisk in 2002 as an independent and non- profit trust dedicated to the prevention and treatment of diabetes in developing countries. The foundation supports sustainable partnerships and acts as a catalyst to help others do more. Since 2002, the WDF has funded 553 projects in 116 countries. The WDF project in Sri Lanka is titled ‘Sri Lanka Diabetes and Cardiovascular Disease Initiative’.
The project is conducted under the supervision of Deputy Director General of Health Services along with the Non-Communicable Disease (NCD) Unit. The Sri Lanka College of Endocrinologists (SLCE) and Sri Lanka Medical Association (SLMA) act as the implementing partners for the project, while the SLCE holds the fund and takes a managerial and technical lead role. The project budget in total is US$ 2,099,999, while US$ 674,999 is funded by the WDF.
The goal
To develop a comprehensive cost-effective and holistic national model for the prevention and control of diabetes and CVD risk factors which would further strengthen and support the existing primary health care systems of the country.
The Mission
• To train staff at PHC level (doctors, Nurses, PHMS, SPHMs, community activists and volunteers) to carry out cost-effective management of NCDs.
• To improve the holistic management of gestational diabetes.
• To train nurses and to empower them as health and diabetes education nursing officers (HENOs and DENOs).
• To develop a national model for the treatment and management of the diabetic foot, and to implement a multidisciplinary service for managing diabetic foot problems.
• To implement a Teacher–Child– Parent (TCP) approach, a model of developing to educate teachers to work with children in order to encourage and empower a healthy lifestyle at home.
• To improve the awareness of the public on healthy lifestyles and to make active decisions on lifestyle changes.
This three-year project consists of two components: Component 1 – Capacity Building at PHC; Component 2 – Health Promotion.
Component 1
Component 1 or Capacity building at PHC aims to support capacity-building for early diagnosis and cost-effective management of diabetes and other cardiovascular diseases at Primary Health Care (PHC) level. The target groups are doctors, nurses, PHM, SPHMs, community activists and the public. The objectives are:
• To develop and implement training programmes for health staff in PHC settings to improve the multi-member team care concept and improved accessibility for care at PHCs.
• To improve awareness among stakeholders and professionals for best buy interventions and need or integrated interventions in prevention.
• To strengthen the public health sector towards a holistic approach to improve screening for early detection of GDM and to improve its care within the maternal and child health network.
• To develop shared care model for the treatment of women with GDM.
• To improve the holistic management of diabetic foot.
• Training of Diabetes Education Nursing officers (DENO).
• To strengthen the existing health information system in PHC.
• To develop centres of excellence at provincial and regional level.
• School health promotion.
Component 2
Component 2 or Health Promotion aims to improve awareness of the public on healthy lifestyles empowering them to make active decisions on lifestyle changes. The target group is schoolchildren and their families and social groups and the community. The objectives are:
• To offer school health interventions through a coordinated effort to increase awareness among stakeholders and children and to encourage healthy behaviour in schoolchildren and parents.
• To develop and strengthen an integrated approach for the prevention and early diagnosis of diabetes and CVD risks among vulnerable populations through health promotion by mobilising the sectors outside health through multi-stakeholder partnerships.
• To design and pilot test an efficient health management information system for diabetes/CVD risks, by application of mobile and web-based technology which can be integrated into the national Health Information System (HIS).
Achievement
SLDC won the Royal College of Physicians’ ‘Excellence in Patient Care Finalist Award 2018’for the abstract, “Battle against diabetes and cardiovascular diseases: achievement of Sri Lanka Diabetes and Cardiovascular Initiative (SLDC),” in which outcomes of SLDC trainings conducted within the first one-and-a-half years were highlighted.
National-level implementation of the school health project, the ‘Chandi Bandi’ intervention which was developed and piloted by SLDC in Colombo is being implemented nationwide for all Grade 1 and Grade 2 students in collaboration with the Ministry of Education, where a total of 750,000 will be benefited.
The project has been running successfully hitting its final milestone and almost all the targets of the project have been achieved. The target of the project is to train and create awareness to 9,285 individuals (including consultants, doctors, nurses, DENOs, PHMs, prosthetists and orthotists, teachers, parents and students) about NCD and diabetes, but since 2016 and till now SLDC has achieved the training of 24,473 individuals.
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A delegation from the World Diabetes Foundation (WDF) will meet with partners, healthcare providers and patients involved in the Sri Lanka Diabetes and Cardiovascular Disease Initiative (SLDC) from November 4 (today) to 7.
WDF, which is providing financial support and expertise to the SLDC, will meet with partners in the Ministry of Health, Sri Lanka Medical Association and Sri Lanka College of Endocrinologists, among others. The visit will include hospitals, clinics and schools in Galle, Matara and Colombo, where the initiative is being rolled out.
According to the Chairman of the Board of Dr. Anil Kapur, Sri Lanka is a leader in the prevention and control of NCDs. “The SLDC is an aggressive, active response anchored in the Ministry of Health and driven by strong leadership, public action and community mobilisation. This type of national-level response is an example to all countries fighting the scourge of diabetes and other NCDs. We look forward to seeing its progress and discussing the next steps with our partners,” he said in a statement.
SLDC’s goal is to develop a comprehensive, cost-effective and holistic national model for the prevention and control of diabetes and other CVD risk factors which would further strengthen and support the existing primary health care systems of Sri Lanka. It is the result of a decade-long partnership between the WDF and partners in Sri Lanka and builds on the learnings from past projects.
The SLDC is currently implementing the first phase of a nationwide diabetes programme in all 25 districts of Sri Lanka.
Its goals include:
• Strengthened collaboration between maternal and child health services, primary health centres and government healthy lifestyle clinics in detecting and managing diabetes, diabetic foot and gestational diabetes.
• Capacity building of tertiary, secondary and primary health facilities and healthy lifestyle clinics
• Roll out of screening, care and referral of diabetes with linkages to community-level health promotion.
• Implementation of awareness and prevention activities.
• Strengthening of health information systems on NCDs.
According to the WDF’s Programme Department Head Hanne Strandgaard, this approach integrates diabetes care into the primary health system, increasing the likelihood that serious complications such as diabetic foot and gestational diabetes are detected well in time. “The achievements in Sri Lanka’s health sector are exceptionally commendable. We look forward to meeting our partners and sharing learnings from this visit with our other partners worldwide,” Strandgaard said.
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The World Diabetes Foundation is a leading global funder of diabetes prevention and care projects in the developing world.
The WDF’s vision is to alleviate human suffering related to diabetes among those in greatest need. The WDF pursues sustainable, scalable approaches, helping countries meet global goals for improved care of diabetes and other non-communicable diseases.
Since 2002, the World Diabetes Foundation has provided US$ 149 million in funding to 558 partnership projects in 116 countries. For every dollar of WDF funding provided, project partners raise approximately US$ 2 in cash or in-kind donations from other sources.
