WHEREAS the world is experiencing a global epidemic of diabetes, the sub-Saharan African (SSA) region has the largest percentage increase in the incidence of diabetes of any region in the world; estimated at 16 million people living with diabetes in year 2017 and with this number expected to increase by 156% in year 2045 associated with the following negatively impacting features:

• high rates of undiagnosed disease with subsequent development of diabetes related complications, disabilities and premature death.
• high cost of management, thereby imposing significant costs both on individuals and on healthcare delivery systems;

WHEREAS the United Nations General Assembly High-level Meeting of September 2011 adopted the Political Declaration on Prevention and Control of Non-Communicable Diseases;

WHEREAS the World Health Assembly of May 2013 endorsed the Global Action Plan for the Prevention and Control of NCDs 2013-2020, and, 
WHEAREAS Member States agreed to set four time-bound commitments towards implementation of the Global Action Plan;
WHEAREAS the Meeting of African Ministers of Health jointly convened by WHO Regional Office for Africa and the African Union Commission, held in Luanda, Angola, in 2014, committed to ensure that prevention and control of NCDs and their risk factors are given the prominence they deserve and that the WHO Global Action Plan on NCDs 2013-2020 is fully implemented through the national NCD multisectoral plans, and through mobilizing resources, both domestic and external, including the use of innovative funding; 
WHEREAS the 2030 Agenda for Sustainable Development and the Sustainable Development Goals adopted by Member States at the United Nations Sustainable Development Summit September 2015 specifically include the reduction of premature deaths from NCDs; and 
WHEAREAS the recent Lancet Diabetes & Endocrinology landmark Commission Publication of 2017 focuses on the agenda of diabetes in sub-Saharan Africa;
WE, THE UNDERSIGNED, as representatives of international organizations, civil society and other non-state actors, HEREBY DECLARE: 
That we met in Dar Es Salaam, Tanzania from 11th to 15th March, 2019 in a workshop organized by the International Insulin Foundation (IIF), East African Diabetes Study Group (EADSG) with the participation of The Lancet Diabetes & Endocrinology Journal and discussed among us three areas as pillars of action: research; clinical training and management; and advocacy as summarized in Table 1. 
Pillars of Action
Research
There is the need for a regional harmonized database to provide robust data on the epidemiology of diabetes and its risk factors and foster research in understanding the phenotype and the genetics of diabetes and other diabetes subtypes in sub-Saharan Africa. 
Clinical training and management
Develop simple and context-adapted clinical diabetes management guidelines, create a model of training of mid-level healthcare professionals and health extension workers focusing on task shifting and capacity building, and developing centres of excellence for training in sub-Saharan Africa.

Advocacy
Local actions towards universal health coverage with the inclusion of diabetes; improving the availability and affordability of diabetes care, especially insulin; community outreach and community participation in the development and implementation of diabetes care services; and build, educate and empower diabetes civil society and other patient-oriented groups which can serve as efficient agents of advocacy. 

 
The specific goals for the three overarching action pillars included:

• To reduce the prevalence, incidence, co morbidities and untimely deaths in relation to diabetes;
• To build the capacity of health systems to provide the highest possible standard of quality diabetes care;
• To build capacity locally to improve providers’  ability to suspect, diagnose and manage diabetes and its complications;
• To address the psychosocial and economic needs of people with diabetes; 
• To conduct relevant implementation research to improve policies;
• To avail diabetes prevention and management resources and commodities sustainably

AND, TO THIS EFFECT WE AGREE to enhance our joint efforts, accelerating implementation of national diabetes responses in our countries, with emphasis on, but not limited to, the following key strategies:

• Establish a regional working coalition for the setting of a large and harmonized database to provide robust data on the epidemiology of diabetes and its risk factors in sub-Saharan Africa following standard and rigorous methodologies to inform policy making and implementation. 
• Expanding research on understanding the phenotype and the genetics of diabetes and other diabetes subtypes in sub-Saharan Africa. 
• Development of simple and context-adapted clinical diabetes management guidelines for diabetes in children and adults; gestational diabetes and other specific subtypes based on up-to-date evidence that can be applied across the strata of healthcare services in the different countries in sub-Saharan Africa. 
• Create a model of training of mid-level healthcare professionals and health extension workers to provide adequate, basic and cost-effective services to diabetes patients while also focusing on task shifting and capacity building. 
• Strengthen local actions towards universal health coverage for all with the inclusion of diabetes and other NCD services with a strong axis for the decentralization of these healthcare services to breach inequality which affects the poorest communities.
• Developing, renewing or refining national multi-sectoral NCD strategies and action plans in alignment with the WHO Global Action Plan and based on STEPS surveys and other available data and information, and on tangible achievements from countries of sub-Saharan Africa. 
• Establishing or strengthening multisectoral national NCD steering committees under government leadership in order to ensure involvement and commitment of health as well as non-health stakeholders including, but not limited to, civil society, academia, professional societies, media, and, other non-state actors 
• Enhancing sustainable diabetes health care commodities through effective procurement and import substitution by attracting pharmaceutical companies to produce in sub-Saharan African countries.
• Raising awareness on diabetes and its risk factors through continuous education, community outreach and community participation in the development and implementation of diabetes care services in order to promote early diabetes detection. 
• Build and educate diabetes civil society and other patient-oriented groups which can serve as efficient agents of advocacy toward local country governments and regional organizations including the African Union. 
• Establish knowledge transfer and exchange platforms at country levels including relevant government services, policy makers, public/private research institutions and patient groups for a multi-sectoral approach to the prevention and control of diabetes and associated risk factors. 
• Establishment of centres of excellence for the training of early career clinicians and investigators in diabetes care and research via network and collaborations platforms, capacity building in good clinical practices and grantsmanship with the end result to attract funding for diabetes research in the sub-Saharan Africa region. 
• The recent emergence of COVID-19 means that understanding of transmission patters, severity, clinical features and risk factors for infection was paramount and a gateway to a rapid transformation of the approach to public health strategies, research, and clinical care for patients with diabetes , both during current pandemic and in future outbreaks. 

Endorsed in Dar Es Salaam on 20th August 2020 by we as listed below: 
International Insulin Foundation (IIF)

Kaushik Ramaiya
Wenceslaus Sseguya
Chair
Secretary 

For the International Insulin Foundation (in alphabetical order)

David Beran
Member Diabetes Center of Faculty of Medicine, Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals.

Geoff Gill
Emeritus Professor of International Medicine, Liverpool School of Tropical Medicine.

John S. Yudkin
Emeritus Professor of Medicine, University College London

For the East Africa Diabetes Study Group (EADSG), (in alphabetical order)

Silver Bahendeka
Associate Professor of Medicine, MKPGMS-Uganda Martyrs University

Kaushik Ramaiya
Director and CEO, Shree Hindu Mandal Hospital, Tanzania | Hon Professor of Medicine London School of Tropical Medicine & Hygiene

Andrew Swai
Professor of Medicine, Tanzania Diabetes Association 

Wenceslaus Sseguya
Secretariat, EADSG, Uganda. 

For Major Journals and Publications

Neil Bennet
Acting Executive Editor, Lancet Diabetes and Endocrinology

Invited Faculty

Theonest Mutabingwa
Professor at Kairuki Memorial University, Founder and past President Tanzania Non-communicable Diseases Alliance

Moffat Nyirenda
Professor of Medicine and Global NCDs, London School of Hygiene and Tropical Medicine and MRC/UVRI LSHTM Uganda Research Unit

Other Signatory Delegates to the Workshop (alphabetical order)

Haregeweyni Alemu
Institute for Healthcare Improvement, Ethiopia

Merhawit Atsbha
Mekelle University, Ethiopia

Faraja Chiwanga
Muhimbili Hospital, Dar es Salaam, Tanzania

Tawanda Chivese
University of Cape Town, South Africa

Justin Cikomola
Catholic University of Bukavu, Democratic Republic of Congo

Pamela Donggo
USAID Integrated Health Systems Project, Uganda

Given Hapunda
University of Zambia, Zambia

Jean-Claude Katte
University of Yaounde 1, Cameroon

Tavares Madede
University of Cape Town, South Africa

Edna Majaliwa
Muhimbili Hospital, Dar es Salaam, Tanzania

Kandi Muze
Muhimbili Hospital, Dar es Salaam, Tanzania

Laurien Sibomana
Life for a Child, Rwanda