Peer educator networks for diabetes and hypertension in Cambodia

1. Peer educator networks for diabetes and hypertensionin Cambodia Health literacy, ICT & empowerment

2. If there are access-to-chronic-care problems such as… • costly distance • unreliable drug supply • unresponsive services • long waiting times • over-loaded medical staff • exclusion • lack of certain services • lack of referral to other specialisations • over-pricing (cf. reference) • unnecessary services • inappropriate information

3. ….this opens a market for involvement of chronic patients “Unmet needs” create opportunities… Chronic patients meet at the home of the community-based Peer Educator

4. Tasks of a Diabetic Peer Educator PE core tasks: • Organize screening Diabetes, High Blood Pressure & CKD & DBR +++ • Counsel, assess new patient, register: create a record (=EMR) • Train patients in self-management • Be intermediary: Make appointments on behalf of patient with Dr • Follow-up by outreach to patient’s home if necessary; • Set up Village HBP Groups in each village, maintain monthly visits • Report monthly to ODPM (OD Peer Network Manager (salaried); Selected PE extra tasks: • Some help organize 2x/yr the blood collection for lab service (at Public HC) • Some help in Medical Consultation sessions (OPD only at Public Hospital) • Some help supervise & run Revolving Drug Fund (Public + Private) • Some join in Primary prevention activities Distribute voucher to the poor patients for 70% discount on medicines (Revolving Drug Fund)

6. From 2005 until October 2013: 15,539 members 11 sub-networks in 13 health districts (OD’s) AREAS: • Phnom Penh (3 OD’s) : 5 poor areas (1 OPD) • Takeo province: all 5 OD (6 OPD’s) • BanteayMeanchey : 1 OD (1 OPD) • KompongSpeu : 2 OD‘s (2 OPD’s) • Kompong Thom : 2 OD’s (2 OPD’s) SERVICE INFRASTRUCTURE: • 22 Contracted pharmacies (4 public) • 12 OPD’s in Public Referral Hospitals • 129 Peer Educator (129 HC areas) • 553 Village HBP Groups BENEFICIARIES per October 2013: • 537,883 adults self-screened (UG strip) • 8,369 DM patients registered • 338 DM self-injecting Insulin • 7,170 HBP patients (non-diabetic)

7. Health Literacy inOutputs & Outcome Re-assessments + Rewards (yearly..?) Physical Outcomes (15) Patient Book filled (3) Nutrition habits (7) Physical activity (4) Medical care (6) Knowledge of disease (3) Feeling well (5) Total = 43 indicators

8. ICT for empowerment of: 1. Groups& 2. Individual Patients Integration TYPES of data: 1. Clinical + 2: Self-Management + 3. Medicine Supply + 4. Use

9. Use Database as a tool… : • Calculate supply needs Revolving Drug Fund • Measure % adherence to prescribed medication • Measure performance by main actors by area • Patients themselves • PE’s (degree of patients under control) • Doctors’ prescribing • Pharmacists dispensing • Determine financial rewards for the main actors • Long term cohort records • Measure use of special subsidies/discounts

10. Example 1: ICT for group power Generates data for financial reward : (A + B)/2 * C A) % of Satisfaction among patients who used public pharmacy at least 2 times (PE-routine-survey); B) % of Adherence to prescribed medication over past 12 months C) multiplied by 15% of the value of dispensed medication to chronic patients over the same period; Reward was SHARED as Payment for Performance among: Provincial Health Department, 1% Operational District Office, 3% User Fees of the Public Hospital, 36% Pharmacist of the Public Hospital 60%

11. Example 2: ICT for individual power Laboratory profile : • In Khmer Language • Result Trend over time • PE trained to explain and counsel • Lab profile offered at 30% of market prices • External Quality Assurance System

12. final slide ! Sustainability & Acceptability