Primary health care approach to Diabetes mellitus in Malawi

Diabetes Mellitus (DM) is one of non-communicable diseases that have public health significance. In Malawi, it is estimated that diabetes prevalence rate is 5.6% among the age group 25-64 in the year 2009. In Malawi, diabetes has not gained adequate attention in terms of all resources such as personnel, medicinal and laboratory equipment and reagents. Primary Health Care approach to the management of diabetes is not only low labour intensive but improves patient retention as well especially in rural areas. Health Education, for instance, improves self- care and life style. Adopting this strategy will help poor Malawians affected with diabetes access the much needed care affordably. Nurse-led diabetes clinics strategy hits two birds with one stone in that remote areas –where nurses already working- could be easily provided with the services and nurses are the most available cadre in the hands of the Ministry of Health. So, Primary Health Care (PHC) approach, if carefully used, will help Malawians affected with diabetes to have access to the much needed care thereby improving their own quality of life.


Opinion
Globally, Dm is becoming a major public health problem and mostly affecting the low and middle-income countries. It is estimated that 285 million people live with diabetes worldwide and expected to hit as high as 436 million by 2030 [1]. In Africa about 12 million were estimated to have Dm in the year 2010 and this number has increased to 14.7 million in 2011 [2] The WHO STEP wise approach to chronic disease risk factor surveillance estimated the prevalence of Dm in Malawi to be 5.6% among the age group 25-64 in the year 2009 [3]. A prevalence of 5.6% is an alarming level which requires the government of Malawi, through the ministry of health to innovatively respond to this new epidemic. To better handling this health problem, it is wise to adopt feasible and pragmatic approach putting in mind the position of Malawi on the world economic and health classification. In this view point, we strongly recommend this approach so as to mitigate the morbidity and mortality of diabetes in Malaawi.

The Malawi Government position On Diabetes
Until the year 2011 there was no specific directorate in the Ministry of Health to address the Non-communicable Diseases (NCD), but this year the directorate has been established and the NCD Approach could be a better and feasible way out.

Primary health care features and capability to address diabetes
Though the PHC is the currently functioning system, there are some challenges facing the implementation such as accessibility to health services and shortage of resources. [5] The PHC was adopted during the WHO meeting in 1978 as key approach to the health of the world. PCH emphasizes and advocates for the points that formulate the concept. These can be summarized as; access, equity, essentiality, appropriate technology, multisectral collaboration, and community participation and empowerment. As thus, the concept comprehensively clears some worries that might be raised in regard to the human resources and materialistic resources and even the technical capacity.

Successful stories used low-cost interventions in rural settings
Diabetes care in resource limit settings can be optimised with more innovative ways with no much costs implications. A nurse-led service, for instance, has improved retention of patients in remote areas. There are several studies showed that a Dm single recall system managed by local healthcare workers and supported by a diabetes out-reach service has good results in improving care and reducing hospitalization in a high risk population. This teaches us that diabetes could be handled in rural areas. In areas where people are underserved this new approach could bring good results, especially in areas like rural Malawi. This approach will also facilitate the integration of care for some Non-Communicable Diseases (NCDs) such as Hypertension, Asthma and Epilepsy at low costs and non-physician clinicians and nurses.

Health education and diabetes
Health education for patients with type 2 diabetes is an efficient tool in improving care without affecting the health care costs. Health care costs cause real qualms in most Africa, so with this approach financial allocations will be so minimal. Health education, amazingly, has wonderful positive results in most of the diabetes care angles. It The current service delivery system in Malawi has no capacity to address the Dm burden in the rural areas as the accessibility and availability of the healthcare generally is a real challenge. However, we have tried to explain how Malawi could do much more to tackle diabetes and its complications if the PHC approach is adequately employed and sustained.

Recommendations
We strongly recommend the following if the diabetes care is to be improved despite the human resource and financial constrains: campaigning for diabetes care and alerting the health care workers about the extent and complexity of the disease as well as the general public; Ministry of Health has an opportunity to adopt the PHC approach with regard to the magnitude of the problem and the existing health system capacity. More efforts should be directed towards a robust health education for diabetes.