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Introduction:
The aim of the IIF is to study the problems that patients face accessing proper care and insulin for their diabetes in developing countries.
In order to study the barriers to access, the IIF developed the Rapid Assessment Protocol for Insulin Access (RAPIA). The RAPIA provides a practical field guide to assist teams in the collection, analysis and presentation of data to evaluate and inform the development of health care services for diabetes management in low and middle income countries.
The development of the RAPIA was made possible with the financial support of the World Diabetes Foundation (Pilot in Mozambique), WHO and Diabetes Foundation (work in Zambia), Diabetes Foundation (work in Mali), a collaboration with Handicap International (work in Nicaragua) and support of the IDF for work in Vietnam.
The RAPIA is structured as a multi-level assessment of the different elements that influence the access patients have to insulin and diabetes care in a given country. The framework of the RAPIA studies the path of insulin from its arrival in the country to the point that it reaches or fails to treat the patient effectively and thereby identify how and where the system works and/or fails.
This approach to the evaluation of health care services draws on the principles of Rapid Assessment Protocols (RAP) which have been developed and implemented in different areas. The method of RAP has been used extensively to assess services for communicable diseases, including malaria, tuberculosis and STDs, for the purpose of developing interventions. The approach chosen here is to adapt existing protocols to suit the assessment of access to insulin. (back to top)
The main principles of the RAPIA are:
- Speed – the methods are intended to provide relevant information quickly, upon which decisions about health care interventions can be made.
- Use of multiple data sources – different methods are used to access different sources of data to get a balanced overview.
- Pragmatism – the methods should provide adequate information, without necessarily being ‘scientifically perfect’. Triangulation, or cross-checking between different sources of data is used to establish the validity and reliability of the data collected.
- Cost-effectiveness – the focus is on research instruments that provide information cheaply, and are not labour and time intensive. Where possible, use is made of existing data. (back to top)
Objectives:
In order to achieve the broad aim, the RAPIA has the following objectives:
- To provide a range of data collection tools, from which research teams can select those appropriate to their own situation;
- To provide suggestions of data items to collect;
- To provide suggestions on data sources, data collection, data analysis and data presentation for each of the tools presented.
The RAPIA will provide the tools to enable a research team to collect information on the structure and functioning of insulin supply services/practices and also to conduct an assessment of the quality of care currently provided to people with Type 1 diabetes.
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Structure:
The RAPIA is a series of questionnaires aimed at the following people within a country:
- Ministry of Finance
- Ministry of Trade
- Ministry of Health
- Private Sector
- National Diabetes Association
- Central Medical Store
- Educators
- Regional/District Health Organisation
- Hospitals, Clinics, Health Centres and Dispensaries
- Pharmacy/Drug dispensaries
- Laboratories
- Health workers
- Traditional doctors
- Patients
Each questionnaire aims to assess the barriers each of these levels of the health sector face with regards to Insulin. (back to top)
Results:
Information will be collected, analysed and discussed to develop policy recommendations to identify and remove the barriers that hinder accessibility of Insulin to all those who need it.
Depending on the information gained during the RAPIA process, the measures for implementation can include:
- Supporting countries to tender for bulk purchase of reliable sources of Insulin at the lowest cost;
- Assistance in distribution of Insulin in countries;
- Assistance in establishing and implementing Essential Drug Policies;
- Advice on revision of local tax regulations for Essential Drugs;
- Support for good practice in storage and distribution of Insulin;
- Improving availability of Insulin syringes and monitoring equipment;
- Dissemination of educational programmes for managing Type 1 Diabetes by health workers at regional, district and primary health care level, and by patients and their families;
- Collection of reliable information on prevalence and morbidity of Type 1 Diabetes in these countries (back to top)
Click here for more information about the RAPIA
Implementation:
A pilot of the RAPIA has been carried out in Mozambique with the financial support of the World Diabetes Foundation and in Zambia and Mali with the support of the Diabetes Foundation (UK based charity) and the WHO. In collaboration with Handicap International the IIF carried out the RAPIA in Nicaragua. Depending on future funding the IIF hopes to be able to assist as many countries as possible with this protocol. (back to top)
Link to the IIF’s work in Mali
Link to the IIF’s work in Mozambique
Link to the IIF’s work in Nicaragua
Link to the IIF’s work in Vietnam
Link to the IIF’s work in Zambia
The Diabetes Foundation Report on insulin-requiring diabetes in sub-Saharan Africa:
Based on the IIF’s in-country experience and with the funding of the Diabetes Foundation, this report looks at the current patterns of disease, and the care provided for, patients with insulin-requiring diabetes in sub-Saharan Africa. It compares the three countries where the IIF has worked and draws on this experience to develop specific recommendations for concrete action to tackle the problems identified.
This report adds significantly to the current data on diabetes and its care in sub-Saharan Africa and provides a pointer to how health services for diabetes, and other chronic diseases, might be strengthened. It is meant as a reference for health planners, clinicians, diabetes associations and other interested parties involved in improving the care for people with diabetes in sub-Saharan Africa. Link to the report
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The Diabetes Foundation Report on implementing national diabetes programmes in sub-Saharan Africa
Many African countries are now facing a growing challenge of an increasing number of people with hypertension, stroke, coronary heart disease and diabetes in addition to communicable diseases. This has been called the ‘double disease burden’ and poses challenges to resource-poor countries, in part because of the demands it places on health systems to invest in the provision of both the ongoing delivery of medicines and the knowledge and training of health care workers in managing chronic disease.
Problems identified by the World Health Organization related to healthcare organisation and Non Communicable Diseases (NCDs) are:
- Failure to organise care for chronic conditions;
- Health care workers lack tools and expertise;
- Practice is not informed by scientific evidence;
- Failure to address prevention;
- Information systems are not in place;
- Failure to connect with community resources.
This report was prepared using the IIF’s field experience, discussions with key opinion leaders, a thorough review of the literature and the proceedings of two meetings organised by the International Diabetes Federation (IDF) Africa Region and WHO AFRO held in Nairobi (2-3 March 2006) and in Bamako (29-30 June 2006). The aim of this document is to provide a guide to countries in sub-Saharan Africa wishing to implement a National Diabetes Programme. Link to the report
The Diabetes UK Mozambique Twinning Initiative
With the support of Diabetes UK the IIF has been continuing its work in Mozambique. This work aims to build on the recommendations of the RAPIA implementation in Mozambique and supports the following activities:
- Training of trainers programme initiated by the Ministry of Health;
- Specialised training;
- Visit of Dr. Carla Silva-Matos, Head on Non Communicable Disease Deaprtment, Ministry of Health, Mozambique, to the UK;
- Development of patient education materials;
- Organisation of World Diabetes Day activities;
- Advocacy and policy support to Ministry of Health;
- Development of a core group of people involved in diabetes;
- Development of diabetes association;
- Long-term research programmes in Mozambique.(back to top)
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