Beyond Scaling Up: Organising people with Diabetes to manage their disease in Cambodia
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Beyond Scaling Up: Organising people with Diabetes to manage their disease in Cambodia

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This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was ...

This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Van Pelt presented on the self management of diabetes in Cambodia through the mopotsyo network.

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    Beyond Scaling Up: Organising people with Diabetes to manage their disease in Cambodia Beyond Scaling Up: Organising people with Diabetes to manage their disease in Cambodia Presentation Transcript

    • A Peer Educator Network “P.E.N.” for chronic NCD care + prevention Self management by People With Diabetes (PWD) www.mopotsyo.org 1
    • Cambodia’s Transition Double Disease Burden : CD + Chronic NCD Low Income Country 13,500,000 population >1,000,000 chronic NCD > 255,000 People With Diabetes 90% of PWD get no care 72% of PWD are unaware International consensus on LIC health priorities excludes care for chronic NCD (spooky WB 2007 report ) www.mopotsyo.org 2
    • Universal Access to what ? Scale-up only for CD, not NCD Allocation of resources to selected needs; Chronic NCD are left to markets: Market Failure Annual Health Donor Millions USD $0.8 $6.3 $9.3 Admin MCH Comm.Dis. $43.7 Non Comm Dis. www.mopotsyo.org 3
    • Result of neglect of NCD: Severe LIC Health System failures 1. Weak agency on behalf of chronic NCD patients..... 2. No one tells them what they need to know 3. Patients bear the full costs of their disease O.O.P. 4. No chronic care, no realistic model except the current veterinary model (biological patient) 5. Incentives favor disease/cure instead of health & self-help; 6. Standard care package is unaffordable for average citizen; 7. Prescription has been mostly “captured” 8. Not enough trained health professionals www.mopotsyo.org 4
    • But, in fact…. plenty of opportunities in LIC ! 1. If you purchase Out-Of-Pocket…you decide 2. Costs can be slashed, real value can be improved. 3. Enough “patients” who are eager to learn 4. Slow disease means enough life-time left to learn 5. Lay people (non-medical) have less conflict of interest than medical staff in sharing knowledge; 6. Lay people are inter-sectoral 7. Lower cost favors adherence by PWD/chronic patients 8. Set cost to patient at <10% of GNI per capita 9. Lay people are cheap; 10. Task shift to lay people reduces health system stress www.mopotsyo.org 5
    • Real Public Policy challenge from NCD in LIC = to push & favor optimal mixes of these opportunities 4 different levels of self management Patients become People Affordability to patient becomes a key who get their act together, take initiative Agency of and involve in design, Chronic patients management & Peer Educator in governance of their Public Health Role problems and Peer Educator in relation to fellow Patients solutions….as part of the overall health Patient Self-Management system www.mopotsyo.org 6
    • Pyramid’s Ground Floor: Self-Management by PWD 1. Joining in 6 group lessons at home of PE 2. Get >monthly blood glucose at PE 3. Self-Measuring urine glucose (multiple ways) 4. Result Recording in own patient book Patient Self-Management 5. Healthy eating (follow food pyramids) 6. Sufficient physical activity 7. Improving maintaining weight 8. Buying medicines monthly + adherence to prescription 9. Not smoking, not heavy drinking 10. Joining in 6-monthly assessments 11. Join in monitoring, community actions 12. ….if HBP, peer educating on HBP…..eventually hosting www.mopotsyo.org 7
    • Low mid-level: Peer Educator as Expert PWD in relation to other PWD 1. Sharing & Counseling, 2. Registering & Assessing Peer Educator in relation 3. Informing & training, to other Patients 4. Hosting at home 5. Monitoring-service providing-supplying-selling 6. Guiding to professional health services 7. Welcoming & helping to navigate the hospital 8. Confronting…..coaching...blaming…abandoning ..? www.mopotsyo.org 8
    • High-Mid level: Peer Educator as Public Health Expert Peer Educator in Public Health Role 1. Organising Screening chronic NCD 2. Health Promotion on Risk Factor Control 3. Actual facilitator of access to services 4. Local Eyes & Ears: Monitoring and reporting 5. Mobilising members when necessary www.mopotsyo.org 9
    • Pyramid’s Top Agency Chronic patients Self-Management at Agency level 1. Patient representation at health policy level 2. Purchasing public health services (health promotion, screening, getting better deals, bringing costs down) 3. Revolving Drug Funds (at least governance) 4. (e.g. Laboratory) Services www.mopotsyo.org 10
    • Potential Risks/Weaknesses 1. Weak peer : weak patients 7. Timely referral 2. Narrow view of health 8. Multiple roles: counseling, 3. What is right balance sharing, informing, service between under- and over providing, explaining, incentivising; guiding, welcoming at 4. Compete with professionals hospital, blaming…? 5. Co-morbidities 6. Credibility in diabetes • Standards of means local credibility on care…...whose? more diseases • Agency Governance / capture www.mopotsyo.org 11
    • In summary: public policy challenge with regards to care for chronic NCD in Low Income Countries 1. End the “defaitism” on care for chronic NCD. Yes, it can be a black hole but not if… 2. We help chronic patients in LIC get themselves organised instead of letting them down as we do now……....………....No? www.mopotsyo.org 12
    • Acknowledgements support from www.mopotsyo.org 13