Diabetes Alliance / NDoH February 2020 meeting
- Itumeleng Setlhare: National Dept of Health (NDoH)
- Aadila Fakier, Magda Kriel, Nolwazi Sindane: BD
- Susie Snell, Belinda Lister, Nhlanhla Gumede: Roche Diabetes Care
- Juliet Fearnhead: Pick n Pay
- Patrick Ngassa Piotie, Jane Muchiri: University of Pretoria, Tshwane Insulin Project
- Peane Maleke, Mirroph Mashego: Boehringer
- Michael Brown: CDE
- Philip Marais: Momentum
- Chantall Nakin: Medtronic
- Heloise Steyn: Abbott
- Trevor McCoy: Sanofi
- Bridget McNulty: Sweet Life
Apologies from companies who couldn’t send representatives
- Sandhya Singh: NDoH
- Stephen Cook: OSSA
- Sundeep Ruder: SEMDSA
- Mark Norton: DisChem
- Natalie Brandt: Lilly
- Marianne Reid: University of the Free State
- Tshepo Maaka: Cabblow Studios
- Margot McCumisky: Diabetes South Africa
Purpose of the meeting
The goal is to put together a process map and action plan for the projects we will work on together this year (Diabetes Alliance and NDoH), with an emphasis on diabetes educational materials + training, and developing a Diabetes Directory for SA.
- Ideal Clinics vs. other public clinics
- Diabetes Registry for SA
- Diabetes Alliance focus
Ideal Clinics vs. other public clinics
- Itumeleng explained the difference between Ideal Clinics and other public clinics. More information on Ideal Clinics here: https://www.idealhealthfacility.org.za/
- Ideal Clinics are assessed and scored, with the aim of improving the quality of care provided. They can be rated as silver, gold or platinum, with a feedback report. HR is a big problem in the primary healthcare sector: retaining quality staff is difficult. The incentive to be an Ideal Clinic is also to retain quality staff.
- What percentage of clinics are Ideal Clinics? Itumeleng will check.
- Most of NDoH’s problems are around infrastructure: they don’t have the resources to attend to structural challenges. The intention is for all clinics to be ideal, that is going to assist with the NHI.
Diabetes Registry for SA
In order to solve the problem, we need to understand the scope of the problem of diabetes in SA: we need to know how many diabetics there are, and whether or not they are controlled.
Questions from NDoH:
- Who’s going to own the registry? Who’s going to manage the resources?
- Cancer registry has a budget to make it work: resources are going to be needed. Resources are necessary to make it a success.
- Why do we need a registry?
Answers from Dr Patrick Ngassa Piotie, Tshwane Insulin Project at University of Pretoria
- In the 2014 NDoH document for ideal clinics, it was outlined that a registry for all patients was a necessary tool to improve care. If you don’t measure it, you can’t manage it
- We currently have the number of visits but not the number of patients – there might be 80% uncontrolled diabetics, but we don’t know it
- The diabetes registry should be a facility resource, led by an Ideal Clinic NCD Champion. It could be paper based or electronic, but should be a management tool, owned by the facility.
- If anyone else (universities, Diabetes Alliance etc) wants to access it, we would make an application.
- At the moment, any data from the clinics goes to the NDoH office, it doesn’t go to the clinicians – they are working in the dark. You need to switch on the light first. There needs to be a system of some kind for the clinicians who are overworked to bear fruit. Otherwise when their patients develop complications they have no background.
- There would need to be training on the objectives of the registry. To put it in and make it available is one step. The next step is to use it to forecast on medications required (supply chain), visits and compliance issues, and flag issues on patient management. We would need to equip the users to make it effective.
- Why is it in the document if it isn’t being implemented?
Response from NDoH:
- NCDs are funded from our taxes. HIV has conditional grants, like PEPFAR and so on – they augment the public purse so that they can increase the management of HIV. As it is right now, we don’t have outside partners who are pumping funds into NCDs.
- What about sugar tax special projects? Sugar tax special projects funds are distributed across all health promotional materials.
- We recognise that you cannot manage the problem if you don’t know how big the problem is. The govt is trying its best to address this.
- As it is right now, we don’t have enough nurses to attend to the patients. If we give them extra responsibilities when we don’t have enough nurses to attend to patients, that is an issue.
- If we introduce this registry, it needs to be nationalised. Each and every facility would be obliged to complete the registry as part of the workflow.
- As it is right now, all programs have got their own records that need to be filled in. NDoH recognises that we need to nationalise all these papers into one so that clinicians can spend more time with patients.
- We also have the Strategic Plan for NCDs that is currently under development. At the end of that plan, we are going to have an M&E (Monitoring & Evaluation) framework. One of those things is monitoring control. According to the guideline, each patient must have an HbA1c to say whether or not they’re controlled.
- Let’s agree on a system that can work in a South African context – maybe not computers, maybe not internet, as cost-effective as possible.
- We can start on a smaller scale and once we find out it’s working we can scale.
- Having the data at clinic level is really important. We can start with a pilot study, just a few clinics where we know people are champions.
- Could we explore a diabetes version of MomConnect or something similar?
Magda Kriel, BD: Could we use the CCMDD project as a pilot?
- CCMDD is for patients who are controlled: they can pick up 3 months treatment from the pharmacy and go to the clinic once or twice a year.
- How do they know if they’re controlled? UP collected data from CCMDD and non-CCMDD patients: 70% of CCMDD had an HbA1c over 7. To qualify as a stable diabetic patient, you have to have two fasting glucose levels in range (CCMDD guidelines).
- Majority of patients on the CCMDD programme shouldn’t be on it. But clinicians don’t have a picture. Data goes to NDoH.
Diabetes Alliance focus
Trevor McCoy, Sanofi: What is it that we need to do as a small action or initiative?
- What is the most pressing thing that we can assist the NDoH with?
- Let’s show that this forum has fundamentally contributed to a gap in the management of diabetes. What are the low hanging fruits that we can tackle as a group?
Response from NDoH:
- Our issues are multi-sectoral: supply and demand. Patients are not empowered enough to make informed decisions – that is low hanging fruit to empower patients (education)
- From the supply side, as a department: we are aware that there might be challenges around the implementation of our clinical guidelines. How do we strengthen the training of the clinicians so they do what they’re supposed to do?
- For all this to happen, we need infrastructure.
Susie Snell, Roche: Education need among patients, education need among clinicians.
- We’ve all missed the opportunity for consumer education: nobody has created grade 4 to 7 level education, which research shows is the level of health literacy of South Africans at public clinics.
- Clinicians: SEMDSA is launching better primary care training, making moves towards solving those problems.
- How do we train to equip and broaden the base of knowledge amongst healthcare workers? This training programme is more accessible and affordable than what’s currently available. It’s part of a strategy of building capacity around primary healthcare workers (nurses and doctors).
- It also focuses on NQF accreditation – mostly on diabetes nurse educators.
- NDoH is a bit sceptical about that because then remuneration will have to follow. We need to find a balance.
Diabetes education in schools?
- How much is diabetes education in schools already? Schools have Life Orientation. Maybe that is one of the opportunities that we can explore – incorporating diabetes information into the School Health programme through the Dept of Basic Education: diet, healthy living, the reason why you have to pay sugar tax
- If you educate children it can make a big difference. Perhaps a mnemonic that could be used for patients, nurses, doctors, children.
Summary of plans before May 2020 meeting
- May meeting: Friday 8th May, 10am to 12pm (meeting invite to follow)
Solving the problem of education: education, training and empowerment for patients and HCPs.
Patients and public healthcare professionals.
A project plan for diabetes education in public clinics, for both patients and HCPs.
Review materials, create a package of what can be used, how it can be used and amended. Create an action plan for 2020 with deliverables.
- Belinda Lister, Roche: project leader
- Patrick Ngassa Piotie, TIPS: UP
- Jane Muchiri, TIPS: UP
- Magda Kriel, BD
- Michael Brown, CDE
- Trevor McCoy, Sanofi
- Heloise Steyn, Abbott
- Ankia Coetzee (SEMDSA): invite
- Bridget McNulty, Sweet Life
- NCD Strategy deadline is next week, second draft will have the diabetes cascade.
- How do we take small steps towards ensuring we develop a Diabetes Registry that will give us an indication of how big the problem is? All of us in this room agree that that is an ideal state. The education project is starting the process.
- Thank you to everyone who attended for dedicating their time to ensuring good things for the management of diabetes this year.