1. International Diabetes Federation

2. Capacity Building Diabetes Project (2007-2009) Cardiovascular Disease Project (2010-2013) Davao City, Philippines Capacity Building Diabetes Project (2007-2009) Cardiovascular Disease Project (2010-2013) Davao City, Philippines

3. Contents Handicap International Philippine Context The Diabetes Project The Cardiovascular Disease Project Challenges Key Results Lessons Learned

4. Handicap International (HI) Associations worldwide form the Handicap International Federation France Switzerland Luxemburg Germany United Kingdom Canada United States Belgium

5. Why is HI involved in the fight against diabetes? Because every 30 seconds, a leg is amputated somewhere in the world because of diabetes. Because diabetes is a disabling disease for 20-50% of diabetics. Because countries with limited resources are the worst affected by the diabetes “epidemic”, and the poorest communities in particular.

6. HI and its Partners Can…….. 1.Strengthen local associations of persons with diabetes 2.Strengthen health facilities with training, equipment and networking 3.Improve therapeutic patient education 4.Facilitate access to drugs and biological examinations for all 5.Encourage primary prevention in partnership with the state and local organisations 6.Prevent diabetic foot by: a)educating on foot care, b)adapted footwear, c)orthoses or prothesis, d)foot care by health care providers

7. HI and its Partners Can…….. 7.Support rehabilitation for diabetic persons with disabilities 8.Promote inclusion of persons with diabetes in: a)Society and family, b)The world of work, c)Education, d)Sports and leisure activities 9.Engage in advocacy directed at the international community and the governments of countries with limited resources to make diabetes a public health priority.

8. Philippines  Population in 2010 : 94 million  Barangays – smallest unit of government with a highest population of 222,000. DIABETES AND CVD  Diseases of the heart (1), vascular system (2) and diabetes (8) leading causes of mortality.  Diabetes prevalence: 7.6% (2007) and 9.3% (2025)  Among the top 10 countries with highest number of diabetes cases by 2030.  Leading risk factors by rank : Smoking (35%) Hypertension, Obesity, Hypercholesterolemia Diabetes

9. Davao City

11. Davao City before the Diabetes Project

12. The Diabetes Project Aims to increase access to multidisciplinary, integrated diabetes management at the level of communities. Using a Local Inclusive Development Approach Capacity building of:  Service providers  Self-help groups  Policy makers

13. The Diabetes Project Capacity building of health and rehabilitation service providers by: 1.Training of primary health care professionals and community health workers 2.Develop systems and tools for  General information  Patient education  Health service provision and referral 3.Skills upgrading of prosthesis and orthotics technicians

14. The Diabetes Project

17. The CVD Project TITLE Capacity Building Project for the Prevention of Complications and Disabilities Linked to Cardiovascular Disease. MOTTO Building Partnerships, Improving Lives  Local Inclusive development  Replication of good practices now covering the entire city  Emphasis on partnership building  Sustainability

18. The CVD Project Capacity Building of Health and Rehabilitation Service Providers Organisational Development of Local Diabetes Support Groups Awareness Raising AdvocacyEstablishing Peer Education Availability of Health Services Increasing the demand for the services Policy Development for institutionalization and funding among others ENABLING ENVIRONMENT FOR: Lifestyle change Delivery of Quality, sustainable service Prevent Complications, Reduce Disabilities, Improve Lives Building Partnerships

19. 1.City Government / City Health Office – primary implementer, policies, budget 2.Department of Health – Healthy Lifestyle Campaign, Technical Support 3.Southern Philippines Medical Center – technical support, referral institution 4.Davao Jubilee Foundation –technical support, referral institution 5.Handicap International – coordination, technical support, funding

20. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

21. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

22. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

23. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

24. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

25. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

26. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

27. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

28. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

29. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

30. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

31. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools adaptation and development 3.Setting up laboratory services

32. Building the Capacity for Service Provision: Strengthen and build on existing Primary Health Care Services through: 1.Training for service providers and trainers of service providers 2.Processes and tools development 3.Setting up laboratory services

33. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

34. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

35. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

36. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

37. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

38. Organizational Development : Strengthen and build on existing Local Diabetes Support Groups (LDSG): 1.Organization development and project development trainings 2.Establishment of Peer Support 3.Support the formation of an LDSG federation

39. Awareness Raising :

42. Advocacy :

44. Challenges: 1.Charity mindset 2.Building a participatory environment 3.The politics of health 4.Task shifting 5.Public’s lack or urgency

45. Davao City Today : Health Services:  Services institutionalized with 178 Barangay Health Centers offering services for diabetes and CVD  Laboratory services established in the 14 District Health Center and the City Health Office main laboratory  3,845 screened for diabetes and other risk factors  2,312 registered / enrolled in the CVD program  26 Diabetes Educators (CVD Program Trainers)  252 Trained Primary Health Care Professionals  1641 Trained Community Health Workers

46. Davao City Today : Organisations  4 organisations with legal identities  374 organisation members  2 organisations with peer support committees with 19 peer support volunteers  Federation of 6 Local support groups formed Policies developed:  CVD Program Partnership  World Diabetes Day every November 14  World Heart Day every September 29  Revision of the City Tax Code to include laboratory services  Proposed budget of 20 million for 5 years

47. At least 1 year is needed to: 1)Establish name and credibility 2)Introduce the project and the approach 3)Develop relations with stakeholders and establish trust 4)Define stakeholder roles 5)Formalize partnerships 6)Define strategies and activities with project partners 7)Organise and capacitate the project team 8)Conduct a proper baseline study During project development give time for building solid foundations Lessons Learned:

48. 1.Consistency of approach 2.Look for a champion/s 3.Define next steps with relevant stakeholders 4.Participatory definition of stakeholder roles 5.Institutionalise the partnership 6.Create a working structure Lessons Learned:

49. Looking Ahead: Manual of Operations for Non Communicable Disease Prevention and Control Federation of Local Diabetes Support Groups Health and Rehabilitation Service Providers Academe City Social Services City Engineers Office MULTISECTORAL APPROACH MAINSTREAMING NCD INTERVENTIONS City Sports Office City Information Office City Agriculture Office Association of Barangay Captains Student Organizations Professional Medical Organizations

50. DAVAO CITY