Session title: Diabetes in society and culture - 1

Session type: Oral Poster

Track: Diabetes in Society and Culture

Presentation number: OP-0085

Abstract title:

Peers for health: community health worker led diabetes hypertension screening awareness program for rural and urban poor

Presenting Author: M Manjunath.

Background

"Help them help themselves" - for the 'Bottom of the socioeconomic pyramid".

Type 2 diabetes prevention and care for poor and needy: Type 2 diabetes prevention and care needs committed, multifaceted and long-term approach. Most importantly, it has to reach all sections of society (at least minimum level of care), especially the 'underserved' and 'unserved' rural and urban poor (i.e., bottom of the socioeconomic pyramid).

Aim

'Peers" [themselves suffering from disease] and their family members, often display the unique human character of 'empathy", leading to altruism and commitment to help fellowmen. On a foundation of empathy, empowerment and evidence based medicine, this project envisions increased awareness, accessibility and affordability, to contemporary diabetes and hypertension prevention and treatment strategies, to the economically underprivileged and socially neglected (supplementing any existing / future governmental programs - public private partnerships).

Method

Peers for Health or Madhura Sanjeevini project of Samatvam Trust and Jnana Sanjeevini Medical Center, Bangalore, India, has attempted [20l3 - current] to implement community-based healthcare model with Peer Leaders - Community Health Workers [PL/CHWs], to improve diabetes and hypertension screening, monitoring, and health education of the low-income rural / urban slum population around Bangalore, India; The potential of this model for improved early diagnosis, treatment outcomes and disease prevention, has been evaluated. Operational and financial aspects of the model are being refined to ensure future sustainability and scalability. [Project target: 50000 adults in the low-income population from the villages / urban slums within 50 kilometers radius from Bangalore City].

Resources for the PL/CHW: Health Screening Consumables: Blood glucose strips and needles; Equipments: BG meter (2), BP meter (2), Weight scales (2), foot screen etc (2); Health Education: Health leaflet (2 pages, kannada and english): Diabetes and heart health - Power of prevention - The answer is in your hands; Health posters: 2 display posters, for dissemination at public places / congregations. Diabetes and heart health: The answer is in your hands (Kannada and English; 16 page booklet) - for initial learning.

Innovative Information - Telecommunication Technology in community diabetes care: 1. Each person screened was given a specific identification number + the new National Unique Identity Number - 'Aadhar".  2. JS Health - Community version software [Electronic Medical Record]: Initially, CHWs recorded data in bound registers [CHW Register] during house to house survey for each person screened. A very simple hand held Electronic Diary for the CHW was also developed. 3. Real-time database implementation: Subsequent visits will use hand-held devices to transfer data and can be entered via phone by CHW.

Results

18 PLs / CHWs [patients with diabetes or their family members - spouses, mothers, daughters, daughters-in- law, sisters etc], were identified, selected, trained, supported and deployed in their own communities. These PL/CHWs were recruited from among the rural / urban poor families attending the DISHA DOSTI Free Diabetes Clinic for the Poor, at Jnana Sanjeevini Medical Center- JSMC, Bangalore City, India. Each of the PL/CHWs boosted the health and wellness levels of their communities [villages] by providing door-to-door affordable screening and monitoring services [diabetes, hypertension], and health education. They also facilitated initial and continued medical care of the identified patients, in coordination with JSMC and local medical facilities.

MadhuraSanjeevini [2013 - Current]Number [Percent]
Families Enrolled	491
People screened	2880
Diabetes: Newly Diagnosed	175	[6.1%]
Known Diabetes Identified	360	[12.5%
Hypertension: Newly Diagnosed	317	[11.0%
Known Hypertension Identified	243	[8.4%]

Diabetes and / or Hypertension patients follow-up - TOTAL 503 
Follow up: Jnana Sanjeevini Medical Center                         196
Follow up: Other medical facilities	                                         205
Follow up: Nil / inadequate / improper	                                102

Discussion

Peer Leaders / Community Health Workers can serve as vital 'Health Ambassadors" for their own community, and boost the health and wellness levels of their communities [villages, urban slums]. Systematic and sustained peer and community health worker led diabetes and hypertension screening and awareness program, has the potential to be a cost effective and socially relevant 'primordial / primary” health intervention program for 'Preventive Diabetology". Communities will benefit from increased awareness and earlier screening, thus allowing for earlier-stage diagnosis and treatment intervention. Public health significance: This model can bring about a substantial improvement in the lives of India's under served rural / urban poor population, and reduce the ultimate community and national burden of diabetes and its complications.