A downward health care referral system in Bangladesh through diabetic association branches

Track 5. Diabetes

Care Organisation

Other parameters also recorded were: type of treatment, self-glucose monitoring, macro and microvascular complications and comorbidities. Conclusions: The mobile diabetes care clinic demonstrated to be effective in delivering good quality care readily available to the population, and to significantly improve most measurable parameters of diabetes control.

P1578 Diabetic Team and primary Cam Staff Cooperation in a Managed Care Envimnment H. KHANINA-DROZDOV. Mzccabi Health Servise, Beer-Sheva, Israel Diabetic centres play a crucical role in diabetes care. Mutual staged diabetes menagement of diabetes health care team and primary care providers is belived to ensure main goals in diabetic patient management. Our team consists of a diabetologist, a dietitian, a diabetic nurse and a chiropodist. We are responsible of the diabetic servise of 130 000 citizens in the Negev District (the diabetic register exceeds 2500 patients). The patients are treated by 66 Primary Physicians in polyclinics and private practice offices situated up to 60-70 km far from the diabetic center. Diabetologist consults in 5 large centers so that the longest way for a diabetic patient from a small town or a village is less than 20 km. Most of the patients are served in 28 local polyclinics. Over 36% or our patients do not perfom Hb Ale during a year and 46% have their Hb AlC exceeding 8. Only 30% of diabetics have been yet consulted by a diabetologist. To control the situation we trained one nurse in any local polyclinic to manage diabetic patients. For this purpose 28 local nurses were taught in a special two-days course. They are responsible for checking an annual observation schedule. connecting a patient with a dietitian, solving self-monitoring problems, introdusing (if nessesary) to a social worker, providing an oral and written information. A patient poorly controled according to the UKPDS criteria is introdused to a General Physician to make corrections in the treatment or immediately to a diabetologist and to a diabetic team. If after 6 months of observation and treatment due to the GP recomendations the goal is not acheaved, the patient is introdused to a diabetologist by a nurse responsible for diabetes patients. According to this schedule, an average reduction of Hb AlC to 1.8% is revealed during 6 months of observation.

P1579 Decentralization of Diabetes Health Care Delivery in Bangladesh through Branch Activities S.H. HABIB, S. Lahiry, F.U. Mahtab, A.K. Azad Khan, L. Ali. Health Economics Unit, Diabetic Association ofBangladesh, Dhaka, Bangladesh Like many other developing countries Bangladesh is facing a great challenge to provide health care services to its vast number of diabetic population which is increasing at an alarming rate. Decentralized health care system is absolutely required for this purpose, but public hospitals and health care centres do not have adequate services for diabetic patients particularly in peripheral areas. Realizing the importance of decentralization Diabetic Association of Bangladesh (DAB) initiated its Branch activities in mid-seventies with a unique model of community patticipation, local level leadership and autonomy, and friendly supervision and monitoring through a flexible system of affiliation. The present study aimed to investigate the functional and economic efficiency of the model through analyzing the records of Central DAB and the Branches. Growth in number of Branches was found to be slow in the beginning (5 upto 1980 and 11 upto ‘85); however, it has become a highly popular movement in the last decade (46 upto ‘99). Total number of registered patients in the Branches is 66848 with a total patient visit of 501091 to the Branch facilities in 1999. Two hundred and eighty four physicians and 1292 supporting staff are now working in the Branches. A closer analysis of the records of 3 branches at different levels of development (Chittagong, relatively well developed: Feni, moderately developed; Chandpur, developing) showed a total capital investment of US$ 515830 (own resources), 1215080

& Economics

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(Govt. and other grant 955789 + own resources 259291) and 90696 (own resources). The respective recurrent expenditures are US$76956, 14127 and 13637. The receipt generated through selling services to nondiabetics and affluent diabetics were US$ 124107, 22001 and 13400 showing a cost recovery (in terms of recurrent expenditure) of 161.27%, 155.73% and 98.25% in the respective 3 centres. The findings suggest that Branch activities through the DAB model may be a popular, functionally effective and financially viable model, and can be adopted in other developing countries.

P1580 A Downward Health Care Referral System in Bangladesh through Diabetic Association Branches A. ALI, S. Lahiry, A.K. Azad Khan, L. Ali, S.H. Habib. Health Economics Unit, Diabetic Association of Bangladesh, Dhaka, Bangladesh Diabetes mellitus is increasing at an epidemic rate in developing countries and designing proper health care delivery for patients in these countries is a challenging task. The peripheral and remote areas poses a special problem since the limited health care facilities in the public sector are almost discrete in nature with existence of only a rudimentary and disorganized upward referral. To ensure accessibility and affordability of higher level health care services by the people in these areas Diabetic Association of Bangladesh (DAB), in collaboration with its Branches dispersed all over the country, initiated a Health Care Program from mid-90s where experts are taken to a particular Branch on specific prepublicized dates. They provide secondary and tertiary levels of care (using the infrastructure of the Branch as well as portable instruments carried from the Centre) to diabetic (mostly free) as well as to non-diabetic patients (mostly paid). The present study was aimed to review the efficiency and direct economic performance of the Program through analyzing the records of the central DAB as well as Branches who arranged the camps. Starting in May 1995 33 camps were arranged upto the end of 1999 with moving average of 4.5, 6, 7, 7.5 and 9 (every 2 years) which show an upward trend. A total number of 21, 952 patients were given health care. Three hundred and fifty-four Specialist visits from various disciplines, 324 Medical Officer visits, 210 technician and health personnel visits took place in the Camps. Apart from organizers and employees of the Association considerable enthusiasm and participation were observed among the local community leaders irrespective of political affiliations. The direct cost of the camps (borne by the Centre) was US$ 101,998. The Branches, in turn, earned US$ 147,860 that remained with the individual Branches for the care of diabetic patients. In addition diabetic patients got free care and some potential patients were diagnosed first time. The findings suggest that the Health Camp Program is an increasingly popular and useful program that can be made economically viable with proper design and can be adopted in other developing countries.

P1581 Basic Care of Diabetic Patients through Self-Sustaining Approach: A Bangladesh Experience I. ISLAM, F.U. Mahtab, A.K. Azad Khan, L. Ali. Health Economics Unit, Diabetic Association of Bangladesh, Dhaka, Bangladesh

In the context of the challenge to generate continuous resources for diabetes care, particularly in developing countries, the Diabetic Association of Bangladesh (DAB) has created a unique example by providing basic health care to a large number of diabetic patients (around 300000 registered patients in all of its projects) free of cost. However, the dependence on extra-organizational funds (government, charity etc) for capital cost and for about 30% of tbe recurrent cost may raise question regarding the sustainability and financial viability of its projects. As a pilot to provide basic health care to diabetic patients totally with self-generated resources by cross-financing DAB initiated, from mid-1996 a special Project -