Diabetes in Africa: The role of Clinical Education

Africa's Silent Killer

Diabetes was once considered a rare disease in sub-Saharan Africa.

But now, in 2016, more than 1 in 30 Africans suffer from this life-long, disabling condition.

While, in the developed world, people living with diabetes can expect swift diagnosis and a long and disability-free life; in the developing states of Africa, the picture is shockingly different.

The life expectancy of an African child diagnosed with Type 1 Diabetes, for example, is as short as7 months; the same child in a developed country has a normal life expectancy.

But if we know that rates of diabetes are exploding across the continent, and that African diabetics are already at significantly increased risk of complications and death, what should we be doing about it?

Education, education, education.

I believe the expansion and strengthening of clinical education and training systems will be a central component of our response to this pandemic for one key reason;

Healthcare workers lack the tools, confidence and expertise to manage diabetes

Africa suffers a double disease burden: infectious diseases like Malaria, TB and HIV still besiege communities, while in the same households, and often in the same patients, non-infectious diseases like cancer, heart disease and diabetes take their grim toll.

There have been huge gains made in reducing the impact of infectious disease across the continent. Indeed, the explosion of chronic diseases across Africa is partly a result of the success of eradication and control programs for Malaria, TB and HIV which have served to increase life expectancy across the region.

But the systems and strategies which brought infectious threats under control in Africa, are not fit-for-purpose in addressing the chronic, life-long threats that diabetes now poses.

The focus on infectious disease prevention and control over the past two decades, despite its admirable results, has resulted in a generation of African healthcare workers that has little effective, working, knowledge of how to prevent, diagnose and effectively manage chronic diseases like diabetes.

But how do we overcome this skills gap?

For over a year, I worked on a project in rural Swaziland attempting to increase access to diabetes care.

A core component of this project was a comprehensive training package which gave healthcare workers the knowledge and skills they needed to improve the quality of, and access to, services for diabetics in their care.

I can speak from experience when I say that, given the right training (and, crucially, the right level of support) healthcare workers can be successfully empowered to deliver high-quality diabetes services; even in resource-limited settings.

Training programs like these, as envisaged by the World Health Organisation and The Diabetes Foundation, are absolutely crucial in addressing the human resource deficit facing equitable health service delivery on the continent.

And the great thing is, such training programs do not have to delve into forensic detail or biochemical minutae to have an impact - far from it.

Healthcare workers simply need to know the importance of risk factor identification, the benefits of tight control of blood glucose and appropriate strategies for achieving good diabetic control. Furthermore they need appropriate clinical support to reinforce these messages and to give them the confidence to put them into practice for every patient.

So, what do we have to gain from increased clinical education? In my view there are three big wins;

Better Prevention

Interactions with healthcare workers are often the only source that local populations have for accessing knowledge which could improve, or even prevent, their conditions.

We know, for example, that by reducing weight, increasing physical activity and improving diet that most cases of diabetes, and all the tragedy it brings, could be avoided.

It is only with proper training and support that healthcare workers will be able to understand the real benefits of risk reduction strategies; only then can we expect them to become true ambassadors for the healthy lifestyle changes which can save those at risk.

Earlier Diagnosis

Diagnosis is the first step to successful management. Most people living with diabetes in Africa have not been diagnosed, with recent estimates suggesting that around 85% of Africans living with diabetes are unaware of their disease. This leaves them without the protection from risk that appropriate treatment and regular follow-up can afford. With no awareness of the risks of their condition, patients can progress silently to kidney failure, blindness and even limb loss.

Yes, we need greater deployment of essential healthcare technologies - like point-of-care blood glucose measurements. But we also need greater deployment of healthcare workers who know what risk factors to look out for, who know how to screen clients appropriately, and how to conduct and interpret a simple bedside blood test.

The best way to increase our deployment of healthcare workers with the necessary skills to tackle diabetes, and the causes of diabetes, is by training and capacitating those already working in the system.

Smarter Treatment

Numerous studies around the world have consistently demonstrated that diabetes, and its devastating complications, can be controlled if patients are given appropriate treatment with oral and, where necessary, injectable medications.

In Africa there are many barriers to the provision of medications to those who need them and there are many organisations working valiantly to overcome these challenges (including the organisation I currently work for).

But addressing the supply-side problems of diabetes medications, whether by addressing resource constraints, supply chain issues or procurement challenges is only one half of the problem; we need to create demand among healthcare workers - and, through them, demand among patients - for these medications.

Only by educating healthcare workers on the importance of tight blood glucose control can we ensure the robust demand creation necessary to ensure that life-saving treatments will finally reach those in need.

So, what next for clinical education for diabetes?

The answer is; I don't know.

The challenges facing Africa's diabetics are extreme and we need a multi-pronged approach if we are to deliver the coverage, and quality, of care that is so desperately needed.

There is a clear argument, though, that expanded clinical education and training programs offer an effective, lower-cost solution to addressing one of the biggest barriers to equitable health care for people living with diabetes, and indeed other chronic conditions across continent.

We must support these initiatives in our communities and actively advocate for more attention and resources to be allocated to this important element of health systems strengthening. As Nelson Mandela once said;

"Education is the most powerful weapon we can use to change the world"

I'm always keen to hear from others working in the NCD space, particularly those working in health systems strengthening and capacity building.

You can find more of the training materials I developed for healthcare workers in low-resource settingshere on SlideShare. I am more than happy to share the complete training packages for use, or modification, by other Global Health professionals - just drop me a message to get the conversation started!

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