1. Diabetes Project Palestinian Medical Relief Society

2. 2 Project Objectives  Create Diabetes and Hypertension Treatment Workgroups in 30 Palestinian Villages.  Establish a registry of diabetics and hypertensives in these populations  Develop and implement well validated treatment self-treatment protocols and culturally accepted measurement tools (pre-tested for reliability and validity) for community based treatment for disadvantaged diabetic and hypertensive individuals.  Identification of local project leaders in each of the population areas participating in this effort..  Training of project leaders in health promotion/self- management techniques pertaining to diabetes and hypertension.  Collect baseline and ongoing information from each participating individual..

3. 3 Target Groups  The target groups for the proposed action are patients who have Type 2 Diabetes Mellitus, and who are not properly controlled. Type 2 Diabetes Mellitus usually occurs in the over 30 ’ s, amongst both men and women.  The target group will also be living in poverty, because it is usually Chronic Disease patients who are poor that are increasingly carrying the heaviest load of the NCD's burden.[1] The most vulnerable to Chronic Disease are those living under the national poverty line in different countries[2] and "This inequity is creating a rising demand for the provision of cost-effective care and for investment in prevention to reduce these burdens in regions where the social gradient of NCDs has already reversed and in others where it is expected to do so with the advancing health transition".[3][1][2][3]  [1] World Health Organization World health report 1999: Making a difference Geneva: WHO, 1999 [1]  [2] World Health Organization World health report 1999: Making a difference Geneva: WHO, 1999 [2]  [3] World Health Organization World health report 1999: Making a difference Geneva: WHO, 1999 [3]

4. 4 PMRS Management Approach of NCDs  For more than six years PMRS has worked on the development of a new model to combat the epidemic of NCDs in Palestine. This model was built on the fact that managing NCDs is no more a pure medical problem, but rather wider, taking in consideration the environment and the style of living for people. The new model of disease management calls for more integrated approaches in the management of diseases. Such an approach is not just more effective than the pure biomedical one, but also needs much less resources.  The approach advocated by PMRS is the holistic approach in managing the NCDs. This approach had been adopted and practiced in the Center for chronic diseases in Ramallah, and it is to be disseminated into more and more primary health care centers (PHC) across the West Bank and Gaza Strip. The proposed action is to be implemented as part of this mode

5. 5 Actions Action 1: Capacity Building of Doctors and Health Workers. Mention School of Community Health workers here; women only; chosen by the village

6. 6 Actions Action 2: Community Support Groups  This second action will concern work that will facilitate the involvement of carers, families and the local communities in the management of diabetes. This action will involve two main activities: Home visits: The Health Workers will organize home visits to the identified patients with type 2 Diabetes Mellitus. They will use these home visits to answer queries from the beneficiaries and their carers, and deliver health education. These visits are intended to raise awareness on the patient's condition so that they are better equipped to manage it. Community Support Groups: The Health Workers will establish community support groups for both the direct beneficiaries and their carers. These support groups will act as a support network that the beneficiaries and their carers can turn to for advice on the control and management of Type 2 Diabetes Mellitus.

7. 7 Monitoring and Results  What are results

8. 8 Empowerment of diabetics/hypertensives  Developing/ Collating the best set of information pertaining to Diabetes and Hypertension appropriate for underserved Palestinians. This information will be both medical and community-oriented in nature.  Providing this information, under the leadership of participating organizations, to health professionals and patients/families in an electronically appropriate and cost- effective manner using a variety of techniques.

9. 9 Summary Statement  Most experts now believe that the success of any health care organization and, in particular, any managed care effort is predicated on enhancing consumer engagement/individual (or immediate family) management of his/her chronic illness and satisfaction with the care management process. In short we need to empower patients to become equal partners of the health care team.

10. 10 In conclusion,  The only and best hope is to prevent the complications of diabetes  Empowerment of diabetics within a community context can be and is being done  We have reached several thousand diabetics with this community based approach and our hope is to continue to expand internally and to work with other organizations and the Palestinian Ministry of Health to expand the program to the entire country