Sweet Life’s big focus for 2020 is diabetes education research, in alignment with the Diabetes Alliance. As South Africa’s diabetes community, we offer an online space to share information and advice about living well with diabetes, both here on the website and on Diabetic South Africans. But we also want to help bring this education offline, into people’s lives. Each month, we’ll be sharing the research we’ve done into diabetes education in public clinics, in the hopes that it helps someone else looking for answers to diabetic questions! This is the September report. If you want to read the other months, scroll to the bottom of the page.
The focus this month was on DiabetesConnect calls, distribution of the Diabetes Food Guide booklet, continuing the diabetes registry discussion and collating all the November plans for the Diabetes Alliance.
A fascinating look at how externalising diabetes (‘sugar’) can prove helpful in community outreach. Externalising sugar
Following the Diabetes Alliance request that was sent out to all members of the Diabetes Alliance in August, we have had a few promising discussions with potentially interested funders. We have asked for feedback by Friday 30th October 2020, so that we know if it will be possible to move forward with the project.
Diabetes Food Guide booklet
The Diabetes Food Guide, a collaboration with Pick n Pay and supported by Sanofi, has been printed and distributed to Diabetes SA, Youth with Diabetes, the University of the Free State, the Western Cape DoH and individual pharmacies and support groups. Next, we will reach out to the ICPA to see if we can distribute through more independent pharmacies, as well as sending to the NDoH dietician (Rebone Ntsie: Director for Nutrition Programmes at NDoH) and any other interested parties.
At the end of November, we will ask for feedback so that we can iterate a second version. There are two ways to offer feedback:
1. Answer a series of simple questions on WhatsApp.
2. Fill in a more detailed feedback form.
We have booked a session with a behavioural scientist who has worked extensively in HIV/AIDS, to get feedback on how to make it as easy to adopt the healthy behaviours in the book as possible. We will gather feedback from all interested parties so that we can print a revised version in early 2021.
We are working with Dr Patrick Ngassa Piotie from the University of Pretoria on a diabetes registry proposal. We had a fascinating call with Unjani Clinics in September, to try and learn from their experience.
Why we need a diabetes registry:
The challenge that we’ve found is that the primary care facility manager can’t manage the number of patients under their care (Type 2 diabetic patients). The filing system is paper based, every patient has a file and a clinic number, when patients move from one clinic to another, they lose their number and at a new clinic a new file is created. Clinic number depends on the clinic.
Any type of diabetes exercise becomes cumbersome – getting into the filing room to identify who are diabetics and what kind of care they’re receiving. A lot that falls between the cracks. No continuity of care, sometimes the file isn’t accurate in terms of recording, patients aren’t receiving the right care – they’re not controlled. Lots of gaps.
If there’s a registry, the information of diabetic patients is recorded. One can, at a glance, look at the register and see which patients need extra care. Part of the recommendation for Type 2 diabetes care. Such a tool would make a big difference. If you don’t know the number, you can’t manage it.
In terms of cost, there will be costs incurred to develop the system and probably some maintenance costs. Low-cost data collection, how can it work?
Unjani Clinics uses a tablet-based electronic patient management system. Haven’t dealt with Type 1s because of the cost of insulin, largely with Type 2 patients. From a systems perspective, they are able to draw down a list of patients who are either being treated or what tests they’ve had. They make their tablets ‘dumb’, you can steal it but you can’t do anything with it. They don’t use high value tablets, the nurse can continue to use the system on her phone. They insist on reporting through the system – the nurses can use paper but then they need to recapture all that information through the system.
One issue is internet access. There had been efforts to put internet in all facilities but the connection might not always be reliable.
Internet is a problem in some areas, particularly with load shedding. Unjani has tried to find a solution with their technology partners, who are working at enhancing the existing system to be more of an Unjani system that works around the nurse’s workflow. More efficient in data management and efficiency of time management.
The idea is that even if there’s load shedding and internet issues, the system works offline and then it uploads once you’re connected to wifi. UPS keeps the wifi running and tablets are charged.
Generally the model is designed on a single nurse and clinic assistant: there are two tablets, one queues them up and one has the patient record. She would be able to see her notes and what she’s dispensed in the past. Older clinics have more than one nurse (up to four), a tablet per nurse.
The challenge in public clinics is that they know the paper system is obsolete. Why aren’t they moving to computer based? So far from what is happening in the public clinics.
Could it work to get the patients signed up to an app so they are in charge of their condition? Rather than it being clinic led? (We explained about the WhatsApp based system, but it doesn’t cover all diabetic patients, only those who are motivated and choose to sign up).
Where does Unjani fit in?
Unjani Clinics goal is to be NHI service providers, to be accredited. Play a role in health systems strengthening, be it in the current environment or under NHI. Because it’s a low-cost model in terms of cost to the patient, it still needs to be sustainable. 100 clinics at the end of 2021. Then approach NDoH, saying: “These are the health outcomes we’ve been able to achieve, would you like to work with us?” Would like to open up to all nurses (at the moment it’s just black women).
Could the system work in public clinics?
- Patient management system could easily be deployed into government clinics, it’s been built by nurses for nurses.
- Patient walks in, register as quickly as possible (scan ID). It’s as quick as possible in terms of patient time and nurse’s time, capturing as much as we possibly can from a reporting perspective, allowing the nurses freedom to capture their notes.
- Tried to really build this with the nurse in mind. with nurses who have worked in public clinic facilities.
- What we could easily do is license the software for use by government facilities.
- It’s just a matter of training and low cost tablets.
- Provide online training because of COVID: super simple learning.
- The back-end in terms of reporting is separate to it. Information that is uploaded into DHIS is in the back-end. It gets put into the formats that are required.
- They currently have a software license with Dr Sepula’s software and they pay per clinic.
We would need to establish the importance or relevance of the tool – what is the purpose of a diabetes registry, how will it make a difference? It can’t only be for nurses who are seeing diabetic patients: that will become a problem.
Mindset change: perhaps begin with a spreadsheet? Capturing on spreadsheet to capturing on a tablet is not such a mind shift. If the spreadsheet is the starting point, that’s fine. At least you’ve captured information that can be pulled into the system.
Pilot in 3 clinics in Tshwane: nurses understand you’re doing a proof of concept. Make sure it doesn’t add on to the existing workload.
We still need to finalise the proposal and present it to the Diabetes Alliance board and thereafter all members for buy-in.
Diabetes Alliance November plans
Here are the notes from the 11 September 2020 meeting of the Diabetes Alliance, with all the suggested November plans for National Diabetes Month. We have formulated a suggested message for the Diabetes Alliance and NDoH around risk factors – the IDF theme is nurses, with a secondary message of Type 2 diabetes risk assessment. Once this has been approved, we will share it with the Diabetes Alliance.
PnP School Club
One of Sweet Life’s goals for 2021 is to find a way to reach children and educate them about diabetes in an easy-to-understand way. This is both so that they can live healthier lives and prevent Type 2 diabetes, and that they can share the information with their parents.
The Pick n Pay School Club is potentially an avenue for this kind of education – there’s the possibility of getting into 3025 schools to reach learners from Grade 1 to Grade 7 in Life Orientation, Maths and Science.
We are going to look at how we could develop posters and materials around diabetes, and how the teachers and learners could use video or downloadable materials to make diabetes part of their curriculum.
Next steps: October
- Reach out to ICPA, NDoH and others to distribute the Diabetes Food Guide.
- Formulate Sweet Life’s November media campaign.
- Meet with PnP School Club to see what is possible.
- Read IDF Atlas for any relevant local information.
The 2020 Diabetes Education Project by Sweet Life is supported by Pick n Pay and BD.
Read the whole diabetes education research series:
Photo by Dan Dimmock on Unsplash