1. Cambodia Diabetes self-help groups MoPoTsyo Patient Information Centre Maurits van Pelt

2. Our Main Message Diabetes Peer Educator networks should be integrated in the primary health care system

3. But most Health Policy makers say “Chronic Disease interventions are not cost effective” “Chronic Diseases are a black hole, especially for secondary prevention among patients……..”

4. External assistance focus by programs budgets only 1% for Non Communicable Diseases (NCD) although they cause more than half of disease and death Cambodia Health Sector Donors.

5. We say: This lack of policies….breeds poverty! Markets move fast to grab opportunities; Markets create confusing information; Product safety concerns increase Willingness-to-Pay Biggest spender on product promotion wins Consumers do not know what would be their best choice The market’s natural response is supply side centred; All factors combined: It leaves many unmet needs… Premature disability replaces productivity

6. Elements of the Diabetes context Lack of trained Doctors and Nurses; After training, they are severely underpaid; Public health system is only for acute cases; Chronic patients supplement health staff income…; A profitable patient is an ignorant one…; Question: If formal health staff has no incentive to transfer knowledge + skills to chronic patients……then who has ?

7. Diabetics are: Rich.. ? Overweight.. ? Old.. ? Too low educated to self-manage? We often assume that we understand the problems We set priorities for low income countries…. This can be terrifying..

8. Proposed thesis : “ Diabetes Peer Educator Networks are a worthwhile investment for Low Income Countries in Asia like Cambodia”

9. Demand side organisation in NCD A Diabetes Peer Educator Network in an Operational District (a.k.a. zône de santé) led by a manager (a.k.a. DPM) in charge of community based Diabetes Peer Educators

10. The Diabetes Peer Educator Is a self-managing Diabetes patient who may have any profession except health service provider & Is Literate Is Volunteer Was trained 6 weeks in Diabetes Peer Education Has passed the Peer Educator exam

11. What do DM patients actually need ? A) Understand how they can keep their blood glucose and blood pressure always within the safe margins: lifestyle (type of food, exercise, kg) right medication self-measuring B) Understand how they can keep this affordable;

12. Immediate Effects: Distribute urine glucose strips for self - testing: one per adult; Detect DM earlier (70% did not know it) Increase reservoir of aware DM from 30% to 41% in Yr 1 (Yr 2 > 50%) Peer Educator Assesses: Presence of Urine glucose Fasting Blood Glucose Blood Pressure Heart rate BMI Waist circumference Feet inspection, nerve d. etc. …..reports to her/his DPM Benefit 1: Earlier Detection

13. Benefit 2: Transfers Knowledge + skills

14. Benefit 3: Lifestyle changes <12 months

15. Benefit 4: No stress on health services Benefit 4: Avoiding early medicalisation 728 Medical Consultations in 15 months Average 1.8 consult per patient, 160 DM did not yet meet with the Doctor

16. Benefit 5: Cost Containment 1 million patients: 350.000 DM + 700.000 High BP Annual drug bill remains too high if supply side controls while the demand side pays (USD 250 million). Annual drug bill can be low, if demand side controls AND pays (USD 40 million, is mostly affordable…); There will still be a role for targeted subsidies for new poor DM;

17. Benefit 6: Quality of Life DM Patients feel better because they: - Regain control over their health - Spend less than before on health care - Can get health information that they need

18. Benefit 7: Biological outcomes

19. Benefit 7: Overall lower BG

20. Benefit 7: Blood Pressure among DM

21. Example Ang Roka OD 133.000 inhabitants

22. Peer Educator network running costs USD 6700 per year for 665 (2 nd year-) diabetics USD 10 per diabetic per year at current levels A Peer A Day Keeps the Doctor Away! www.mopotsyo.org