Chronic disease, inclusive but not limited to diabetes, is a fast-growing problem in sub-Saharan Africa. Within AMPATH's geographic area of western Kenya, there are already an estimated 60,000 persons living with diabetes, and that number is expected to double over the next two decades. Unfortunately, as the threat of early death and disability from chronic disease like diabetes grows in sub-Saharan Africa, it is clear that countries like Kenya have almost nothing in place to meet this challenge.
Through the collaboration of many partners from both the pharmaceutical industry and academic medical centers, AMPATH is making considerable progress in improving the level of care for resource-constrained patients with diabetes. AMPATH currently provides care, education and medications to patients enrolled in the diabetes clinic at Moi Teaching and Referral Hospital as well as rural clinics in Webuye, Mosoriot, Turbo, Kitale, Huruma, Teso, and Burnt Forest and dozens of dispensaries. AMPATH currently has over 3,000 patients with diabetes mellitus enrolled in the AMPATH program. Of these, over 500 patients are currently receiving or previously received intensive home glucose monitoring (HGM) at Moi Teaching and Referral Hospital (MTRH) and Webuye. This highly effective intervention has also made significant strides in reducing the long term complications by reducing the average blood glucose by more than 30%. However, there remains a considerable amount of work to be done to improve accessibility and availability of services, overall glycemic control and long-term outcomes for diabetic patients.
Rural populations of low socioeconomic status such as western Kenya face considerable and unique barriers to high-level health care especially for chronic disease management. For many, there is little access to capital, reliable supplies of medications or laboratory services and the distance to and cost of travel to clinic can be prohibitive. These barriers can result in poor clinic attendance, poor continuity of care and a break down in patient-provider communication.
To address these barriers and access to chronic care management,
AMPATH is using their existing perpetual home-based counseling and
testing initiative to reach patients with diabetes. The initiative
sends community health care workers door-to-door to test for
HIV/AIDS, and in locations where patients have access to chronic
care monitoring at AMPATH rural clinics and dispensaries, the
health care worker is also testing for hypertension and
In addition, AMPATH has launched a program called BIGPIC (Bridging Income Generation with Provision of Incentives for Care) in which diabetes and hypertension screening and monitoring are bundled with existing community-based microfinance groups. The microfinance self-help groups are set up in rural, resource constrained environments and meet twice a month to collect contributions from participants in the group. A community-appointed committee then tallies the total amount of money accumulated which is then loaned out to the group members. BIGPIC's role comes in by sending health care workers to attend the microfinance meetings every 1-2 months to monitor the health goals of those enrolled in the program. The aim behind BIGPIC is to provide infrastructure for income generating opportunities while simultaneously
providing portable, high quality, subsidized care that patients can now comfortably afford. By coupling chronic disease management with a finance component, the BIGPIC program has not only shown an improvement in the health of diabetic patients but it has also provided a valuable source of capital that would otherwise be unavailable. Read the BIGPIC executive summary here.