A step-wise manner in improving care Since 2003, the World Diabetes Foundation has invested USD 2.8 million in nine projects in Sudan. Two initial projects led to the establishment of 57 diabetes mini-clinics and 14 diabetes units and centres. Furthermore, 180 doctors and 160 diabetes educators received training. Under a third project, the diabetes centre in the state capital Dongola was upgraded to a tertiary referral centre and has become a centre of excellence for treatment as well as for training medical students. In addition, a mobile diabetes clinic began monthly visits to satellite diabetes clinics in the Northern State. The two projects focusing on children with diabetes, which together covered almost the entire country, have also received support from the Foundation. Building on the success of these projects, the eye care project was devised with the realistic expectation that many children with diabetes will have eye complications and will therefore need early attention to prevent blindness. To date, 291 children and adults have been detected with diabetic retinopathy and 78 of these treated with laser surgery. Amputations, another common complication from poorly managed diabetes, are being addressed in a project which aims to establish 20 diabetic foot clinics at existing health care facilities throughout Sudan following the Step-by-Step model. So far, 11 clinics have been established, 240 health care professionals trained and 14,050 patients have received diabetic foot care and wound dressing at these clinics. 108
Maternal health, one of the focus areas for the World Diabetes Foundation, is being tackled in a project on gestational diabetes mellitus (GDM). By training doctors and midwives in GDM protocols and providing educational material, the project is steadily being extended to more diabetes mini-clinics with the aim of replicating the project in other states of Sudan in the future. This portfolio of projects demonstrates how the project partners have addressed diabetes care in a step-wise manner by first establishing diabetes care facilities in clinics and, secondly, upgrading these through diabetes education of healthcare professionals and patients. Finally, the facilities have been further upgraded to include preventive care (secondary care) and treatment of complications (tertiary care). The most recent project, initiated in 2010, aims to establish and empower diabetes associations in eleven regions of the country. Prof. Eltom, local partner for this project, explains: “As main partners, diabetes associations have a vital role to play in the design and implementation of diabetes strategies. They can identify the needs of the population living with diabetes and promote acceptable methods of implementation. They can fulfil a vital watchdog role and help evaluate the outcome of programme measures. Finally, they have a powerful advocacy function.� A recent update from the project reports that four diabetes associations have already been established, although plans for the establishment