; Strengthening Health Systems for Chronic Care and NCDs
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Strengthening Health Systems for Chronic Care and NCDs


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									 Strengthening Health Systems for
      Chronic Care and NCDs:

Leveraging HIV Programs to Support
   Diabetes Services in Ethiopia
         Zenebe Melaku, ICAP Ethiopia
   Ahmed Reja, Ethiopian Diabetes Association
    Miriam Rabkin, ICAP Columbia University
  Making the HIV-NCD connection
• In many resource-limited countries, HIV scale-up has created
  the first national chronic disease program.
• In these same countries, the burden of other chronic diseases,
  including NCDs such as diabetes, is high and growing rapidly.
• We conducted a rapid proof-of-concept study to explore the
  feasibility of adapting HIV-specific resources for use in a DM
  program at Adama Hospital in Ethiopia.
• Following a baseline assessment, we adapted key strategies,
  systems, and tools originally developed for the Adama HIV
  clinic, and introduced them into the OPD for use with adult
  DM patients. A follow-up assessment was conducted after six
Intervention Package:

    Strategies                      Systems                         Tools
    Introduction of an “essential   Appointment and defaulter       Appointment books
    package” of key services,       tracking systems
    supplies, and equipment
    Use of step-by-step protocols   Training, clinical mentorship   Charting tools, forms
    to guide care                   and supportive supervision      and flow sheets
    Emphasis on family-focused      Peer educator programs          Job aids
    Identification of a limited     Chart review/quality            Patient education
    number of M&E indicators        assessment conducted and        materials
                                    used by clinic staff

•     No new or experimental services were introduced
•     No new clinic was created – DM patients were seen within OPD as before
•     No additional support was provided for medications, laboratory testing or
      transportation, and no new staff were engaged for implementation
•     No changes were made to service delivery or staffing at the HIV clinic
Six-month outcomes included:
• Marked increase in documented service delivery with no added staff;
• Expansion of services to include peer education and point-of-service DM
   screening for patient family members;
• Rapid improvement in standards of care.

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